Journal Article

Long-Term Cost-Effectiveness Model of Interferon Beta-1b in the Early Treatment of Multiple Sclerosis in the United States

Cutter, Gary, Goh, Jo Wern, Pleimes, Dirk, Wang, Cheng, Pan, Feng, Su, Wayne

2012

Overview

Multiple sclerosis (MS) is a potentially debilitating autoimmune disease that affects the brain and spinal cord. Disease-modifying therapies have been shown to slow disease progression but were not believed to prolong the survival of patients with MS. The recent 21-Year Long-Term Follow-Up (21Y-LTF) study found a significant survival advantage for patients receiving early treatment with interferon beta (IFNβ)-1b compared with placebo (no early treatment). The aim of this study was to conduct cost-effectiveness analyses estimating the long-term benefit of early treatment with IFNβ-1b among MS patients from a US societal perspective. A Markov model was developed to simulate the experience of patients with MS from the 21Y-LTF study over a lifetime. Patients were randomized to receive either IFNβ-1b or placebo for up to 5 years and then receive a variety of MS treatments (including no treatment) thereafter. Survival data reported from the 21Y-LTF study were incorporated into the model. The model assumes that patients' MS was managed in similar ways for both groups during the uncontrolled phase of the 21Y-LTF study (ie, survival difference between the 2 groups is the result of early use of IFNβ-1b). Health outcomes were life-years and quality-adjusted life-years (QALYs). Costs included treatments, direct disease management, informal care, and lost productivities and were reported in 2011 US dollars. In the modeled placebo group, the median age at death was predicted to be 63.7 years, and the median survival time from disease onset was 36.7 years. Early treatment with IFNβ-1b reduced the lost health benefits by 2.8 life-years and 1.9 QALYs, respectively, after discounting. Total discounted cost for IFNβ-1b–treated patients was $86,223 higher than that of patients receiving placebo. The incremental cost-effectiveness ratio was $46,357 per QALY gained and $30,967 per life-year gained. Sensitivity analyses indicate the robustness of the model's results. Treatment with IFNβ-1b during the earlier disease phase of patients with MS significantly increased patient life-years and QALYs. IFNβ-1b is likely to be a cost-effective intervention for MS.

• Publisher: EM Inc USA,Elsevier,Elsevier Limited
• Subject: Adjuvants, Immunologic - economics / Adjuvants, Immunologic - therapeutic use / Aged / Autoimmune diseases / Biological and medical sciences / Cost-Benefit Analysis / cost-effectiveness / Disease Progression / Drug Costs / economic / Follow-Up Studies / Humans / Interferon beta-1b / Interferon-beta - economics / Interferon-beta - therapeutic use / Internal Medicine / Markov Chains / Medical Education / Medical sciences / Middle Aged / Models, Economic / Mortality / Multiple sclerosis / Multiple Sclerosis - drug therapy / Multiple Sclerosis - economics / Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis / Neurology / Pharmacology. Drug treatments / Quality of life / Quality-Adjusted Life Years / Sensitivity analysis / societal perspective / Studies / Survival / Survival Rate / Time Factors / United States