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The cost-effectiveness of delayed-release dimethyl fumarate for the treatment of relapsing-remitting multiple sclerosis in Canada.
J Med Econ. 2016 Jul; 19(7):718-27.JM

Abstract

BACKGROUND

Multiple sclerosis (MS) causes significant disability and diminished quality-of-life. Delayed-release dimethyl fumarate (DMF; also known as gastro-resistant DMF) is a new oral treatment for relapsing-remitting MS (RRMS) approved in the US, Australia, Canada, and Europe.

OBJECTIVES

A cost-effectiveness model was developed to compare the health economic impact of DMF against other disease-modifying therapies (DMTs) as first-line RRMS treatment from a Canadian Ministry of Health perspective.

METHODS

A Markov cohort model was developed to simulate patients' progression through health states based on the Kurtzke Expanded Disability Status Scale (EDSS) over a life-time horizon. Patients entered the model based on a distribution of baseline EDSS scores, from which they could progress to higher or regress to lower EDSS state, or remain in the same state. Relapses could occur at any EDSS score. Results from a mixed-treatment comparison were used to inform model inputs for disease progression and relapse rates per treatment. Costs included direct medical costs stratified by EDSS score. Utilities were accrued based on time spent in each EDSS state.

RESULTS

Compared with glatiramer acetate, DMF yielded 0.528 incremental quality-adjusted life-years (QALYs) at an incremental cost of $23 338 Canadian dollars (CAD), resulting in an incremental cost-effectiveness ratio (ICER) of CAD $44 118/QALY. The ICER for DMF compared with Rebif 44 mcg was CAD $10 672. Results were consistent across a wide range of one-way and probabilistic sensitivity analyses.

CONCLUSIONS

Based on traditional cost-effectiveness thresholds in Canada (CAD $50 000-60 000), DMF can be considered a cost-effective option compared to other first-line DMTs.

Authors+Show Affiliations

a Evidera , Bethesda , MD , USA ;a Evidera , Bethesda , MD , USA ;b PIVINA Consulting, Inc. , Ontario , Canada ;c Biogen , Cambridge , MA , USA.c Biogen , Cambridge , MA , USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27080475

Citation

Su, Wenqing, et al. "The Cost-effectiveness of Delayed-release Dimethyl Fumarate for the Treatment of Relapsing-remitting Multiple Sclerosis in Canada." Journal of Medical Economics, vol. 19, no. 7, 2016, pp. 718-27.
Su W, Kansal A, Vicente C, et al. The cost-effectiveness of delayed-release dimethyl fumarate for the treatment of relapsing-remitting multiple sclerosis in Canada. J Med Econ. 2016;19(7):718-27.
Su, W., Kansal, A., Vicente, C., Deniz, B., & Sarda, S. (2016). The cost-effectiveness of delayed-release dimethyl fumarate for the treatment of relapsing-remitting multiple sclerosis in Canada. Journal of Medical Economics, 19(7), 718-27. https://doi.org/10.3111/13696998.2016.1164174
Su W, et al. The Cost-effectiveness of Delayed-release Dimethyl Fumarate for the Treatment of Relapsing-remitting Multiple Sclerosis in Canada. J Med Econ. 2016;19(7):718-27. PubMed PMID: 27080475.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The cost-effectiveness of delayed-release dimethyl fumarate for the treatment of relapsing-remitting multiple sclerosis in Canada. AU - Su,Wenqing, AU - Kansal,Anuraag, AU - Vicente,Colin, AU - Deniz,Baris, AU - Sarda,Sujata, Y1 - 2016/04/15/ PY - 2016/4/16/entrez PY - 2016/4/16/pubmed PY - 2017/6/9/medline KW - Canada KW - Cost effectiveness KW - Dimethyl fumarate KW - Multiple sclerosis KW - QALY SP - 718 EP - 27 JF - Journal of medical economics JO - J Med Econ VL - 19 IS - 7 N2 - BACKGROUND: Multiple sclerosis (MS) causes significant disability and diminished quality-of-life. Delayed-release dimethyl fumarate (DMF; also known as gastro-resistant DMF) is a new oral treatment for relapsing-remitting MS (RRMS) approved in the US, Australia, Canada, and Europe. OBJECTIVES: A cost-effectiveness model was developed to compare the health economic impact of DMF against other disease-modifying therapies (DMTs) as first-line RRMS treatment from a Canadian Ministry of Health perspective. METHODS: A Markov cohort model was developed to simulate patients' progression through health states based on the Kurtzke Expanded Disability Status Scale (EDSS) over a life-time horizon. Patients entered the model based on a distribution of baseline EDSS scores, from which they could progress to higher or regress to lower EDSS state, or remain in the same state. Relapses could occur at any EDSS score. Results from a mixed-treatment comparison were used to inform model inputs for disease progression and relapse rates per treatment. Costs included direct medical costs stratified by EDSS score. Utilities were accrued based on time spent in each EDSS state. RESULTS: Compared with glatiramer acetate, DMF yielded 0.528 incremental quality-adjusted life-years (QALYs) at an incremental cost of $23 338 Canadian dollars (CAD), resulting in an incremental cost-effectiveness ratio (ICER) of CAD $44 118/QALY. The ICER for DMF compared with Rebif 44 mcg was CAD $10 672. Results were consistent across a wide range of one-way and probabilistic sensitivity analyses. CONCLUSIONS: Based on traditional cost-effectiveness thresholds in Canada (CAD $50 000-60 000), DMF can be considered a cost-effective option compared to other first-line DMTs. SN - 1941-837X UR - https://www.unboundmedicine.com/medline/citation/27080475/The_cost_effectiveness_of_delayed_release_dimethyl_fumarate_for_the_treatment_of_relapsing_remitting_multiple_sclerosis_in_Canada_ L2 - https://www.tandfonline.com/doi/full/10.3111/13696998.2016.1164174 DB - PRIME DP - Unbound Medicine ER -