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Disease modifying therapies in multiple sclerosis: cost-effectiveness systematic review.
Farm Hosp. 2020 Mar 01; 44(2):68-76.FH

Abstract

OBJECTIVE

To identify and describe cost-effectiveness studies that evaluate disease modifying therapies in the context of relapsing- remitting multiple sclerosis.

METHOD

A systematic review of the literature was carried out by searching MEDLINE, Embase, the Cochrane Library, LILACS, the Tufts Medical Center Cost-Effectiveness Analysis Registry, the National Health Service Economic Evaluation Database and Open Grey. The search was performed in January 2018 and covered articles published between January 2010 and December 2017. The studies reviewed were payer- perspective cost-effectiveness analyses for interferon beta-1a, interferon beta-1b, glatiramer acetate, teriflunomide, fingolimod, dimethyl fumarate, natalizumab, alemtuzumab and rituximab. The Quality of Health Economic Studies instrument was used to determine the quality of the studies reviewed. Risk of bias was assessed without a standardized tool. An analysis was made of direct costs, quality- adjusted life-years and the incremental cost-effectiveness ratio. Data extraction and evaluation of information were conducted separately by each author.

RESULTS

Four hundred one references were found; nine studies were included. A great degree of variability was identified for several methodological aspects. Two studies that applied the incremental cost- effectiveness ratio (cost) showed no first-line therapy to be cost- effective. A third study demonstrated dominance of interferon beta-1b over placebo (USD -315,109.45) and a fourth paper showed dominance of teriflunomide over interferons and glatiramer acetate (USD - 121,840.37). As regards second-line therapies, dimethyl fumarate was cost-effective in a study that compared it to glatiramer acetate and interferon beta-1a and it was dominant in another study that compared it with glatiramer acetate (USD -158,897.93) and fingolimod (USD - 92,988.97). In the third line of treatment, one study showed natalizumab to be cost-effective as compared with fingolimod, and another study showed alemtuzumab to be dominant over fingolimod (USD -49,221). A third trial demonstrated alemtuzumab to be dominant over natalizumab (USD -1,656,266.07). Many of the trials have sponsorship bias. Eight of the trials received a high QHES score.

CONCLUSIONS

The present paper shows that cost-effectiveness studies have high levels of methodological variability, some of them reaching contradictory results. As a result, it is not possible to determine which disease- modifying therapy is really cost-effective in the context of relapsingremitting multiple sclerosis.

Authors+Show Affiliations

Unit of Clinical Neurology, Department of Medicine, School of Medicine, Universidad Nacional de Colombia, Bogotá. Colombia. Grupo de Investigación en Neurología de la Universidad Nacional de Colombia-NEURONAL, Bogotá. Colombia.. cenavarroc@unal.edu.co.Unit of Internal Medicine, Department of Medicine, School of Medicine, Universidad Nacional de Colombia, Bogotá. Colombia.. elordonezca@unal.edu.co.Instituto de Investigaciones Clínicas, School of Medicine, Universidad Nacional de Colombia, Bogotá. Colombia.. jpag6@hotmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32452318

Citation

Navarro, Cristian Eduardo, et al. "Disease Modifying Therapies in Multiple Sclerosis: Cost-effectiveness Systematic Review." Farmacia Hospitalaria : Organo Oficial De Expresion Cientifica De La Sociedad Espanola De Farmacia Hospitalaria, vol. 44, no. 2, 2020, pp. 68-76.
Navarro CE, Ordóñez-Callamand E, Alzate JP. Disease modifying therapies in multiple sclerosis: cost-effectiveness systematic review. Farm Hosp. 2020;44(2):68-76.
Navarro, C. E., Ordóñez-Callamand, E., & Alzate, J. P. (2020). Disease modifying therapies in multiple sclerosis: cost-effectiveness systematic review. Farmacia Hospitalaria : Organo Oficial De Expresion Cientifica De La Sociedad Espanola De Farmacia Hospitalaria, 44(2), 68-76. https://doi.org/10.7399/fh.11385
Navarro CE, Ordóñez-Callamand E, Alzate JP. Disease Modifying Therapies in Multiple Sclerosis: Cost-effectiveness Systematic Review. Farm Hosp. 2020 Mar 1;44(2):68-76. PubMed PMID: 32452318.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Disease modifying therapies in multiple sclerosis: cost-effectiveness systematic review. AU - Navarro,Cristian Eduardo, AU - Ordóñez-Callamand,Eliana, AU - Alzate,Juan Pablo, Y1 - 2020/03/01/ PY - 2020/5/27/entrez SP - 68 EP - 76 JF - Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria JO - Farm Hosp VL - 44 IS - 2 N2 - OBJECTIVE: To identify and describe cost-effectiveness studies that evaluate disease modifying therapies in the context of relapsing- remitting multiple sclerosis. METHOD: A systematic review of the literature was carried out by searching MEDLINE, Embase, the Cochrane Library, LILACS, the Tufts Medical Center Cost-Effectiveness Analysis Registry, the National Health Service Economic Evaluation Database and Open Grey. The search was performed in January 2018 and covered articles published between January 2010 and December 2017. The studies reviewed were payer- perspective cost-effectiveness analyses for interferon beta-1a, interferon beta-1b, glatiramer acetate, teriflunomide, fingolimod, dimethyl fumarate, natalizumab, alemtuzumab and rituximab. The Quality of Health Economic Studies instrument was used to determine the quality of the studies reviewed. Risk of bias was assessed without a standardized tool. An analysis was made of direct costs, quality- adjusted life-years and the incremental cost-effectiveness ratio. Data extraction and evaluation of information were conducted separately by each author. RESULTS: Four hundred one references were found; nine studies were included. A great degree of variability was identified for several methodological aspects. Two studies that applied the incremental cost- effectiveness ratio (cost) showed no first-line therapy to be cost- effective. A third study demonstrated dominance of interferon beta-1b over placebo (USD -315,109.45) and a fourth paper showed dominance of teriflunomide over interferons and glatiramer acetate (USD - 121,840.37). As regards second-line therapies, dimethyl fumarate was cost-effective in a study that compared it to glatiramer acetate and interferon beta-1a and it was dominant in another study that compared it with glatiramer acetate (USD -158,897.93) and fingolimod (USD - 92,988.97). In the third line of treatment, one study showed natalizumab to be cost-effective as compared with fingolimod, and another study showed alemtuzumab to be dominant over fingolimod (USD -49,221). A third trial demonstrated alemtuzumab to be dominant over natalizumab (USD -1,656,266.07). Many of the trials have sponsorship bias. Eight of the trials received a high QHES score. CONCLUSIONS: The present paper shows that cost-effectiveness studies have high levels of methodological variability, some of them reaching contradictory results. As a result, it is not possible to determine which disease- modifying therapy is really cost-effective in the context of relapsingremitting multiple sclerosis. SN - 2171-8695 UR - https://www.unboundmedicine.com/medline/citation/32452318/Disease_modifying_therapies_in_multiple_sclerosis:_cost-effectiveness_systematic_review L2 - https://dx.doi.org/10.7399/fh.11385 DB - PRIME DP - Unbound Medicine ER -
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