Cost-Effectiveness of Treatments for Relapsing Remitting Multiple Sclerosis: A French Societal PerspectiveReportar como inadecuado




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Objectives

The paper aimed to estimate the incremental cost-effectiveness ratio ICER at the public published price for delayed-release dimethyl fumarate versus relevant Multiple Sclerosis disease-modifying therapies available in France in June 2015.

Methods

The economic model was adapted to the French setting in accordance with the Haute Autorité de Santé guidelines using a model previously developed for NICE. A cohort of Relapsing Remitting Multiple Sclerosis patients was simulated over a 30-year time horizon. Twenty one health states were taken into account: Kurtzke Expanded Disability Status Scale EDSS 0–9 for Relapsing Remitting Multiple Sclerosis patients, EDSS 0–9 for Secondary Progressive Multiple Sclerosis patients, and death. Estimates of relative treatment efficacy were determined using a mixed-treatment comparison. Probabilities of events were derived from the dimethyl fumarate pivotal clinical trials and the London Ontario Dataset. Costs and utilities were extracted from the published literature from both the payer and societal perspectives. Univariate and probabilistic sensitivity analyses were performed to assess the robustness of the model results.

Results

From both perspectives, dimethyl fumarate and interferon beta-1a IFN beta-1a 44mcg were the two optimal treatments, as the other treatments IFN beta-1a 30mcg, IFN beta-1b 250mcg, teriflunomide, glatiramer acetate, fingolimod were dominated on the efficiency frontier. From the societal perspective, dimethyl fumarate versus IFN beta-1a 44mcg incurred an incremental cost of €3,684 and an incremental quality-adjusted life year QALY of 0.281, corresponding to an ICER of €13,110-QALY.

Conclusions

Despite no reference threshold for France, dimethyl fumarate can be considered as a cost-effective option as it is on the efficiency frontier.



Autor: Julie Chevalier , Catherine Chamoux, Florence Hammès, Annie Chicoye

Fuente: http://plos.srce.hr/



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