Abstract
Background
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).
Objectives
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.
Methods
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.
Results
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.
Conclusions
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.
Key words
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Article info
Publication history
Published online: August 20, 2012
Accepted:
July 31,
2012
Identification
Copyright
© 2012 Elsevier HS Journals, Inc. Published by Elsevier Inc. All rights reserved.
