Table 1.
Pharmacoeconomic analyses of disease-modifying therapies of CIS
| Study | Country, base year | Time horizon | Model type, perspective | DMT | Comparators | Health outcome | Results | Sensitivity analyses | Conclusion as stated | QHES score65 | Sponsor |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Caloyeras et al61 | Sweden, 2009 | 50 years | Markov model, societal perspective | Interferon beta-1b | 1. DMT initiated after CIS 2. Delayed DMT initiation after CDMS |
QALY | 1. 12.9 QALYs gained, 10,567 million SEKa 2. 12.4 QALYs gained, 10,911 million SEKa |
Higher ICUR for shorter time horizons | Early treatment “economically dominant” (more effective, less costly) for time horizons longer than 10 years. | 99 | Abt Bio Pharma Solutions, Bayer HealthCare Pharmaceuticals |
| Curkendall et al62 | USA, 2008 | Insurance claims 2000–2008 1 year | NA,b third-party payer perspective | Interferon beta-1b, interferon beta-1a, glatiram er acetate | 1. DMT initiated after CIS 2. Delayed DMT initiation after CDMS |
NAc | No significant difference in all-cause total expenditures: 1. US$31,184 2. US$30,051 |
NA | Higher expenditures for DMT in group 1 may be compensated by savings in other medical expenditures. | NA | Bayer Healthcare Pharmaceuticals |
| Lazzaro et al63 | Italy, 2006 | 25 years | Open cohorts epidemiology model, INHS, societal perspective | Interferon beta-1b | 1. DMT initiated after CIS 2. Delayed DMT initiation after CDMS |
QALY | 1. 7.84 QALYs gained, €I70,I33/€220,4I6 (INHS/societal) 2. 7.49 QALYs gained, €l69,239/€226,022 INHS: ICUR €2,575/QALY (early versus delayed treatment) Societal: early treatment “dominates” delayed treatment |
Both perspectives: higher ICUR for shorter time horizons | Early treatment “dominates” delayed treatment from societal viewpoint. ICUR below assumed Italian willingness to pay per QALY from INHS perspective. | 75 | Bayer Schering Pharma, Italy |
| Iskedjian et al64 | Canada, 2002 | 15 yearsd | Markov model, Canadian MoH, societal perspective | Interferon beta-1a | 1. DMT+MPS after CIS 2. MPS after CIS, DMT+ MPS after CDMS |
QAMLYd | MoH: ICUR CA$227,586/QAMLY Societal: CA$I89,286/QAMLY (early versus delayed treatment) |
Both perspectives: lower ICUR for longer time horizons and alternative utility estimates | Early initiation and long-term treatment may improve the pharmacoeconomic profile of interferon beta-1a. | 69 | Biogen Idec, Canada |
Notes:
a
total costs (direct and indirect),
b
no model-based analysis,
c
no health outcome measures reported,
d
only cost-utility analysis shown.
Abbreviations: DMT, disease-modifying therapy; QHES, Quality of Health Economic Studies; CIS, clinically isolated syndrome; CDMS, clinically definite multiple sclerosis; QALY, quality-adjusted life-years; INHS, Italian National Health Service; €, Euro; SEK, Swedish krona; MoH, Ministry of Health; ICUR, incremental cost-utility ratio; CA$, Canadian dollars; QAMLY, quality-adjusted monosymptomatic life-years; MPS, methylprednisolone therapy of index event/relapses; NA, not applicable.