Skip to main content

Advertisement

Log in

Cost-Effectiveness of Disease-Modifying Therapies in Multiple Sclerosis

  • Demyelinating Disorders (DN Bourdette and V Yadav, Section Editors)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Multiple sclerosis (MS) is a leading cause of disability among young adults and has a significant economic impact on society. Although MS is not currently a curable disease, costly treatments known as disease-modifying therapies (DMTs) are available to reduce the disease impact in certain types of MS. In the current economic downturn, cost-effectiveness analysis (CEA) of therapies in MS has become an important part of the decision-making process in order to use resources efficiently in the face of the rapidly escalating costs of MS. While some studies have reported costs of DMTs at the level of cost-effectiveness thresholds, some have estimated their costs beyond the tolerance level of health care systems. On the basis of the current literature and given the difficulties in accurately assessing cost-effectiveness in diseases like MS, it is challenging to determine whether DMTs are cost-effective. Further population-based studies are required regarding the cost-effectiveness of therapies in MS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Weinshenker BG, Bass B, Rice GP, et al. The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. Brain. 1989;112:133–46.

    Article  PubMed  Google Scholar 

  2. Orlewska E, Mierzejewski P, Zaborski J, et al. A prospective study of the financial costs of multiple sclerosis at different stages of the disease. Eur J Neurol. 2005;12:31–9.

    Article  PubMed  CAS  Google Scholar 

  3. Kobelt G, Berg J, Lindgren P, et al. Costs and quality of life of patients with multiple sclerosis in Europe. J Neurol Neurosurg Psychiatry. 2006;77:918–26.

    Article  PubMed  CAS  Google Scholar 

  4. Gold R, Rieckmann P, Chang P, et al. The long-term safety and tolerability of high-dose interferon beta-1a in relapsing-remitting multiple sclerosis: 4-year data from the PRISMS study. Eur J Neurol. 2005;12:649–56.

    Article  PubMed  CAS  Google Scholar 

  5. Nikfar S, Rahimi R, Abdollahi M. A meta-analysis of the efficacy and tolerability of interferon-beta in multiple sclerosis, overall and by drug and disease type. Clin Ther. 2010;32:1871–88.

    Article  PubMed  CAS  Google Scholar 

  6. Kappos L, Radue EW, O'Connor P, et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010;362:387–401.

    Article  PubMed  CAS  Google Scholar 

  7. Khatri B, Barkhof F, Comi G, et al. Comparison of fingolimod with interferon beta-1a in relapsing-remitting multiple sclerosis: a randomised extension of the TRANSFORMS study. Lancet Neurol. 2011;10:520–9.

    Article  PubMed  CAS  Google Scholar 

  8. DiMarco. American Academy of Neurology (ANA) 63rd Annual Meeting: Abstract S41.007; April 14, 2010.

  9. Clifford DB, DeLuca A, Simpson DM, et al. Natalizumab-associated progressive multifocal leukoencephalopathy in patients with multiple sclerosis: lessons from 28 cases. Lancet Neurol. 2010;9:438–46.

    Article  PubMed  CAS  Google Scholar 

  10. Sorensen PS, Bertolotto A, Edan G, et al. Risk stratification for progressive multifocal leukoencephalopathy in patients treated with natalizumab. Mult Scler. 2012;18:143–52.

    Article  PubMed  Google Scholar 

  11. Paty DW, Li DK. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis: II. MRI analysis results of a multicenter, randomized, double-blind, placebo-controlled trial. UBC MS/MRI Study Group and the IFNB Multiple Sclerosis Study Group. Neurology. 1993;43:662–7.

    Article  PubMed  CAS  Google Scholar 

  12. The IFNB. Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis: I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology. 1993;43:655–61.

    Article  Google Scholar 

  13. The IFNB. Multiple Sclerosis Study Group and The University of British Columbia MS/MRI Analysis Group. Interferon beta-1b in the treatment of multiple sclerosis: final outcome of the randomized controlled trial. Neurology. 1995;45:1277–85.

    Article  Google Scholar 

  14. Clanet M, Radue EW, Kappos L, et al. A randomized, double-blind, dose-comparison study of weekly interferon beta-1a in relapsing MS. Neurology. 2002;59:1507–17.

    Article  PubMed  CAS  Google Scholar 

  15. Panitch H, Goodin DS, Francis G, et al. Randomized, comparative study of interferon beta-1a treatment regimens in MS: The EVIDENCE Trial. Neurology. 2002;59:1496–506.

    Article  PubMed  CAS  Google Scholar 

  16. Durelli L, Verdun E, Barbero P, et al. Every-other-day interferon beta-1b versus once-weekly interferon beta-1a for multiple sclerosis: results of a 2-year prospective randomised multicentre study (INCOMIN). Lancet. 2002;359:1453–60.

    Article  PubMed  CAS  Google Scholar 

  17. Jacobs LD, Cookfair DL, Rudick RA, et al. Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG). Ann Neurol. 1996;39:285–94.

    Article  PubMed  CAS  Google Scholar 

  18. Johnson KP, Brooks BR, Cohen JA, et al. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind placebo-controlled trial. The Copolymer 1 Multiple Sclerosis Study Group. Neurology. 1995;45:1268–76.

    Article  PubMed  CAS  Google Scholar 

  19. PRISMS-4: Long-term efficacy of interferon-beta-1a in relapsing MS. Neurology. 2001;56:1628–36.

    Google Scholar 

  20. Ford CC, Johnson KP, Lisak RP, et al. A prospective open-label study of glatiramer acetate: over a decade of continuous use in multiple sclerosis patients. Mult Scler. 2006;12:309–20.

    Article  PubMed  CAS  Google Scholar 

  21. Mikol DD, Barkhof F, Chang P, et al. Comparison of subcutaneous interferon beta-1a with glatiramer acetate in patients with relapsing multiple sclerosis (the REbif vs Glatiramer Acetate in Relapsing MS Disease [REGARD] study): a multicentre, randomised, parallel, open-label trial. Lancet Neurol. 2008;7:903–14.

    Article  PubMed  CAS  Google Scholar 

  22. O'Connor P, Filippi M, Arnason B, et al. 250 microg or 500 microg interferon beta-1b versus 20 mg glatiramer acetate in relapsing-remitting multiple sclerosis: a prospective, randomised, multicentre study. Lancet Neurol. 2009;8:889–97.

    Article  PubMed  Google Scholar 

  23. Jacobs LD, Beck RW, Simon JH, et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. N Engl J Med. 2000;343:898–904.

    Article  PubMed  CAS  Google Scholar 

  24. Comi G, Filippi M, Barkhof F, et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet. 2001;357:1576–82.

    Article  PubMed  CAS  Google Scholar 

  25. Kappos L, Freedman MS, Polman CH, et al. Long-term effect of early treatment with interferon beta-1b after a first clinical event suggestive of multiple sclerosis: 5-year active treatment extension of the phase 3 BENEFIT trial. Lancet Neurol. 2009;8:987–97.

    Article  PubMed  CAS  Google Scholar 

  26. Comi G, Martinelli V, Rodegher M, et al. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial. Lancet. 2009;374:1503–11.

    Article  PubMed  CAS  Google Scholar 

  27. Kappos L, Radue E-W, O'Connor P, et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. New Engl J Med. 2010;362:387–401.

    Article  PubMed  CAS  Google Scholar 

  28. Polman CH, O'Connor PW, Havrdova E, et al. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med. 2006;354:899–910.

    Article  PubMed  CAS  Google Scholar 

  29. Kobelt G, Berg J, Atherly D, et al. Costs and quality of life in multiple sclerosis: a cross-sectional study in the United States. Neurology. 2006;66:1696–702.

    Article  PubMed  Google Scholar 

  30. Schafer JA, Gunderson BW, Gleason PP. Price increases and new drugs drive increased expenditures for multiple sclerosis. J Manag Care Pharm. 2010;16:713–7.

    PubMed  Google Scholar 

  31. Boggild M, Palace J, Barton P, et al. Multiple sclerosis risk sharing scheme: two year results of clinical cohort study with historical comparator. BMJ. 2009;339:b4677.

    Article  PubMed  Google Scholar 

  32. Weinstein MC, O'Brien B, Hornberger J, et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices–Modeling Studies. Value in Health. 2003;6:9–17.

    Article  PubMed  Google Scholar 

  33. Hakim Z. Using decision-analytic models wisely. J Manag Care Pharm. 2003;9:449–50.

    PubMed  Google Scholar 

  34. Sharac J, McCrone P, Sabes-Figuera R. Pharmacoeconomic considerations in the treatment of multiple sclerosis. Drugs. 2010;70:1677–91.

    Article  PubMed  CAS  Google Scholar 

  35. Asche CV, Singer ME, Jhaveri M, et al. All-cause health care utilization and costs associated with newly diagnosed multiple sclerosis in the United States. J Manag Care Pharm. 2010;16:703–12.

    PubMed  Google Scholar 

  36. Forbes RB, Lees A, Waugh N, et al. Population based cost utility study of interferon beta-1b in secondary progressive multiple sclerosis. BMJ. 1999;319:1529–33.

    Article  PubMed  CAS  Google Scholar 

  37. Parkin D, Jacoby A, McNamee P, et al. Treatment of multiple sclerosis with interferon beta: an appraisal of cost-effectiveness and quality of life. J Neurol Neurosurg Psychiatry. 2000;68:144–9.

    Article  PubMed  CAS  Google Scholar 

  38. Touchette DR, Durgin TL, Wanke LA, et al. A cost–utility analysis of mitoxantrone hydrochloride and interferon beta-1b in the treatment of patients with secondary progressive or progressive relapsing multiple sclerosis. Clin Ther. 2003;25:611–34.

    Article  PubMed  Google Scholar 

  39. Kobelt G, Jonsson L, Miltenburger C, et al. Cost–utility analysis of interferon beta-1B in secondary progressive multiple sclerosis using natural history disease data. Int J Technol Assess Health Care. 2002;18:127–38.

    PubMed  Google Scholar 

  40. Kobelt G, Jonsson L, Henriksson F, et al. Cost–utility analysis of interferon beta-1b in secondary progressive multiple sclerosis. Int J Tech Assess Health Care. 2000;16:768–80.

    Article  CAS  Google Scholar 

  41. Lepen C, Coyle P, Vollmer T, et al. Long-term cost effectiveness of interferon-beta-1a in the treatment of relapsing-remitting multiple sclerosis: an econometric model. Clin Drug Investig. 2003;23:571–81.

    Article  PubMed  CAS  Google Scholar 

  42. Bell C, Graham J, Earnshaw S, et al. Cost-effectiveness of four immunomodulatory therapies for relapsing-remitting multiple sclerosis: a Markov model based on long-term clinical data. J Manag Care Pharm. 2007;13:245–61.

    PubMed  Google Scholar 

  43. Kendrick M, Johnson KI. Long-term treatment of multiple sclerosis with interferon-beta may be cost effective. Pharmacoeconomics. 2000;18:45–53.

    Article  PubMed  CAS  Google Scholar 

  44. Chilcott J, McCabe C, Tappenden P, et al. Modelling the cost effectiveness of interferon beta and glatiramer acetate in the management of multiple sclerosis. Commentary: evaluating disease modifying treatments in multiple sclerosis. BMJ. 2003;326:522. discussion 522.

    Article  PubMed  Google Scholar 

  45. Kobelt G, Berg J, Lindgren P, et al. Modeling the cost-effectiveness of a new treatment for MS (natalizumab) compared with current standard practice in Sweden. Mult Scler. 2008;14:679–90.

    Article  PubMed  CAS  Google Scholar 

  46. • Goldberg LD, Edwards NC, Fincher C, et al. Comparing the cost-effectiveness of disease-modifying drugs for the first-line treatment of relapsing-remitting multiple sclerosis. J Manag Care Pharm. 2009;15:543–55. This study is one of the most comprehensive, well-conducted, and detailed studies evaluating the cost effectiveness of therapies in MS.

    PubMed  Google Scholar 

  47. PRISMS (prevention of relapses and disability by interferon beta-1a subcutaneously in multiple sclerosis) study group: randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. Lancet. 1998;352:1498–504.

  48. O'Rourke KE, Hutchinson M. Stopping beta-interferon therapy in multiple sclerosis: an analysis of stopping patterns. Mult Scler. 2005;11:46–50.

    Article  PubMed  Google Scholar 

  49. Rio J, Porcel J, Tellez N, et al. Factors related with treatment adherence to interferon beta and glatiramer acetate therapy in multiple sclerosis. Mult Scler. 2005;11:306–9.

    Article  PubMed  CAS  Google Scholar 

  50. •• Becker III RV, Dembek C. Effects of cohort selection on the results of cost-effectiveness analysis of disease-modifying drugs for relapsing–remitting multiple sclerosis. J Manag Care Pharm. 2011;17:377–81. This study indicates the impacts of cohort selection bias and the importance of model input parameters on the results.

    PubMed  Google Scholar 

  51. •• Noyes K, Bajorska A, Chappel A, et al. Cost-effectiveness of disease-modifying therapy for multiple sclerosis: a population-based study. Neurology. 2011;77:355–63. This population-based study suggests a substantialy different results from studies using effectiveness data from clinical trials.

    Article  PubMed  CAS  Google Scholar 

  52. Curkendall SM, Wang C, Johnson BH, et al. Potential health care cost savings associated with early treatment of multiple sclerosis using disease-modifying therapy. Clin Ther. 2011;33:914–25.

    Article  PubMed  Google Scholar 

  53. Uitdehaag B, Constantinescu C, Cornelisse P, et al. Impact of exposure to interferon beta-1a on outcomes in patients with relapsing-remitting multiple sclerosis: exploratory analyses from the PRISMS long-term follow-up study. Ther Adv Neurol Disord. 2011;4:3–14.

    Article  PubMed  CAS  Google Scholar 

  54. Tan H, Cai Q, Agarwal S, et al. Impact of adherence to disease-modifying therapies on clinical and economic outcomes among patients with multiple sclerosis. Advances in Therapy. 2011;28:51–61.

    Article  PubMed  Google Scholar 

  55. O'Day K, Meyer K, Miller RM, et al. Cost-effectiveness of natalizumab versus fingolimod for the treatment of relapsing multiple sclerosis. J Med Econ. 2011;14:617–27.

    Article  PubMed  Google Scholar 

  56. Gani R, Giovannoni G, Bates D, et al. Cost-effectiveness analyses of natalizumab (Tysabri) compared with other disease-modifying therapies for people with highly active relapsing-remitting multiple sclerosis in the UK. Pharmacoeconomics. 2008;26:617–27.

    Article  PubMed  Google Scholar 

  57. Ebers GC, Traboulsee A, Li D, et al. Analysis of clinical outcomes according to original treatment groups 16 years after the pivotal IFNB-1b trial. J Neurol Neurosurg Psychiatry. 2010;81:907–12.

    Article  PubMed  CAS  Google Scholar 

  58. Lonergan R, Kinsella K, Duggan M, et al. Discontinuing disease-modifying therapy in progressive multiple sclerosis: can we stop what we have started? Mult Scler. 2009;15:1528–31.

    Article  PubMed  Google Scholar 

  59. O'Connor PW, Goodman A, Kappos L, et al. Disease activity return during natalizumab treatment interruption in patients with multiple sclerosis. Neurology. 2011;76:1858–65.

    Article  PubMed  Google Scholar 

  60. Hernan MA, Jick SS, Logroscino G, et al. Cigarette smoking and the progression of multiple sclerosis. Brain. 2005;128:1461–5.

    Article  PubMed  Google Scholar 

  61. Di Pauli F, Reindl M, Ehling R, et al. Smoking is a risk factor for early conversion to clinically definite multiple sclerosis. Mult Scler. 2008;14:1026–30.

    Article  PubMed  Google Scholar 

  62. Healy BC, Ali EN, Guttmann CR, et al. Smoking and disease progression in multiple sclerosis. Arch Neurol. 2009;66:858–64.

    Article  PubMed  Google Scholar 

  63. Pittas F, Ponsonby AL, van der Mei IA, et al. Smoking is associated with progressive disease course and increased progression in clinical disability in a prospective cohort of people with multiple sclerosis. J Neurol. 2009;256:577–85.

    Article  PubMed  Google Scholar 

  64. Zivadinov R, Weinstock-Guttman B, Hashmi K, et al. Smoking is associated with increased lesion volumes and brain atrophy in multiple sclerosis. Neurology. 2009;73:504–10.

    Article  PubMed  CAS  Google Scholar 

  65. Sorensen PS, Mellgren SI, Svenningsson A, et al. NORdic trial of oral methylprednisolone as add-on therapy to Interferon beta-1a for treatment of relapsing-remitting multiple sclerosis (NORMIMS study): a randomised, placebo-controlled trial. Lancet Neurol. 2009;8:519–29.

    Article  PubMed  CAS  Google Scholar 

  66. Ravnborg M, Sorensen PS, Andersson M, et al. Methylprednisolone in combination with interferon beta-1a for relapsing-remitting multiple sclerosis (MECOMBIN study): a multicentre, double-blind, randomised, placebo-controlled, parallel-group trial. Lancet Neurol. 2010;9:672–80.

    Article  PubMed  CAS  Google Scholar 

  67. Trojano M. Improving combination trials for multiple sclerosis. Lancet Neurol. 2010;9:646–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

A. Manouchehrinia: none; C. S. Constantinescu: board membership (Biogen Idec, TEVA), consultancy (Biogen Idec, MerMerck Serono, TEVA, Bayer-Schering, Novartis, MedImmune, MorphoSyS), speakers’ bureaus (TEVA, Biogen Idec).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cris S. Constantinescu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Manouchehrinia, A., Constantinescu, C.S. Cost-Effectiveness of Disease-Modifying Therapies in Multiple Sclerosis. Curr Neurol Neurosci Rep 12, 592–600 (2012). https://doi.org/10.1007/s11910-012-0291-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-012-0291-6

Keywords

Navigation