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PharmacoEconomics

, Volume 36, Issue 1, pp 67–78 | Cite as

Systematic Review of the Costs and Benefits of Prescribed Cannabis-Based Medicines for the Management of Chronic Illness: Lessons from Multiple Sclerosis

  • Samuel Herzog
  • Marian Shanahan
  • Peter Grimison
  • Anh Tran
  • Nicole Wong
  • Nicholas Lintzeris
  • John Simes
  • Martin Stockler
  • Rachael L. Morton
Systematic Review

Abstract

Introduction

Cannabis-based medicines (CBMs) may offer relief from symptoms of disease; however, their additional cost needs to be considered alongside their effectiveness. We sought to review the economic costs and benefits of prescribed CBMs in any chronic illness, and the frameworks used for their economic evaluation.

Methods

A systematic review of eight medical and economic databases, from inception to mid-December 2016, was undertaken. MeSH headings and text words relating to economic costs and benefits, and CBMs were combined. Study quality was assessed using relevant checklists and results were synthesised in narrative form.

Results

Of 2514 identified records, ten studies met the eligibility criteria, all for the management of multiple sclerosis (MS). Six contained economic evaluations, four studies reported utility-based quality of life, and one was a willingness-to-pay study. Four of five industry-sponsored cost–utility analyses for MS spasticity reported nabiximols as being cost-effective from a European health system perspective. Incremental cost-effectiveness ratios per quality-adjusted life-year (QALY) gained for these five studies were £49,257 (UK); £10,891 (Wales); €11,214 (Germany); €4968 (Italy); and dominant (Spain). Nabiximols for the management of MS spasticity was not associated with statistically significant improvements in EQ-5D scores compared with standard care. Study quality was moderate overall, with limited inclusion of both relevant societal costs and discussions of potential bias.

Conclusions

Prescribed CBMs are a potentially cost-effective add-on treatment for MS spasticity; however, this evidence is uncertain. Further investment in randomised trials with in-built economic evaluations is warranted for a wider range of clinical indications.

Systematic review registration

PROSPERO Registration Number: CRD42014006370.

Notes

Acknowledgements

The authors thank Dr Melina Willson her for invaluable assistance with Covidence software. S. Herzog received funding from the Summer Scholarship program, Sydney Medical School, University of Sydney, Australia. R. L. Morton is funded through an Australian National Health and Medical Research Council (NHMRC) Fellowship, #1054216; and a project grant from the Cancer Australia, Priority-Driven Collaborative Cancer Research Scheme, #1129568.

Author Contributions

SH: Substantial contribution to (1) the registration of the review, the screening of titles, abstracts and full-text articles, the analysis and interpretation of data; (2) drafting and revising the work; (3) final approval of the version to be published; and (4) agreement to be accountable for all aspects of the work. MS: Substantial contribution to (1) the design of the review, the analysis and interpretation of data; (2) drafting and revising the work; (3) final approval of the version to be published; and (4) agreement to be accountable for all aspects of the work. PG: Substantial contribution to (1) the design of the review, the acquisition, analysis and interpretation of data; (2) drafting and revising the work; (3) final approval of the version to be published; and (4) agreement to be accountable for all aspects of the work. AT: Substantial contribution to (1) the review of full-text articles, the analysis and interpretation of data; (2) critical revision of the work; (3) final approval of the version to be published; and (4) agreement to be accountable for all aspects of the work. NW: Substantial contribution to (1) the analysis and interpretation of data; (2) revising the work; (3) final approval of the version to be published; and (4) agreement to be accountable for all aspects of the work. NL: Substantial contribution to (1) the analysis and interpretation of data; (2) critical revision of the work; (3) final approval of the version to be published; and (4) agreement to be accountable for all aspects of the work. JS: Substantial contribution to (1) the analysis and interpretation of data; (2) critical revision of the work; (3) final approval of the version to be published; and (4) agreement to be accountable for all aspects of the work. MS: Substantial contribution to (1) the analysis and interpretation of data; (2) critical revision of the work; (3) final approval of the version to be published; and (4) agreement to be accountable for all aspects of the work. RLM: Substantial contribution to (1) the design of the review, the screening of titles, abstracts and full-text articles, the analysis and interpretation of data; (2) drafting and revising the work; (3) final approval of the version to be published; and (4) agreement to be accountable for all aspects of the work.

Compliance with Ethical Standards

Funding

No funding was received for this study.

Conflicts of interest

Samuel Herzog has no conflicts of interest. Marian Shanahan has no financial conflicts of interest. She has research interests in the economics of cannabis policies, and is leading an economic evaluation alongside an RCT of cannabinoid replacement therapy for the management of treatment-resistant cannabis-dependent patients. Peter Grimison is the principal investigator of a randomised, double-blind, placebo-controlled trial evaluating an oral THC/CBD cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting, which is funded by government body NSW Health, with drug supply by Tilray. Anh Tran has no conflicts of interest. Nicole Wong has no financial conflicts of interest. She is the project manager of an RCT evaluating an oral cannabinoid-rich THC/CBD cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting. Nicholas Lintzeris has received research grants from the Australian NHMRC, and the government body NSW Health, for randomised trials into cannabis-based medicines. He is an academic lead for the Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney, Australia; a co-investigator of an RCT evaluating an oral cannabinoid-rich THC/CBD cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting, and an RCT of cannabinoid replacement therapy for the management of treatment-resistant cannabis-dependent patients. John Simes has no financial conflicts of interest. He is a co-investigator of an RCT evaluating an oral cannabinoid-rich THC/CBD cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting. Martin Stockler has no financial conflicts of interest. He is a co-investigator of an RCT evaluating an oral cannabinoid-rich THC/CBD cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting. Rachael L. Morton has no financial conflicts of interest. She is leading an economic evaluation alongside an RCT evaluating an oral cannabinoid-rich THC/CBD cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting.

Supplementary material

40273_2017_565_MOESM1_ESM.docx (35 kb)
Supplementary material 1 (DOCX 35 kb)

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Sydney Medical SchoolNHMRC Clinical Trials Centre, The University of SydneyCamperdownAustralia
  2. 2.National Drug and Alcohol Research CentreThe University of New South WalesSydneyAustralia
  3. 3.Chris O’Brien LifehouseCamperdownAustralia
  4. 4.Discipline of Addiction MedicineThe University of SydneyCamperdownAustralia
  5. 5.Drug and Alcohol ServicesSouth East Sydney Local Health DistrictKogarahAustralia
  6. 6.NHMRC Clinical Trials Centre, The University of SydneyCamperdownAustralia

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