Modelling the cost effectiveness of interferon beta and glatiramer acetate in the management of multiple sclerosis

Objective To evaluate the cost effectiveness of four disease modifying treatments (interferon betas and glatiramer acetate) for relapsing remitting and secondary progressive multiple sclerosis in the United Kingdom. Design Modelling cost effectiveness. Setting UK NHS. Participants Patients with relapsing remitting multiple sclerosis and secondary progressive multiple sclerosis. Main outcome measures Cost per quality adjusted life year gained. Results The base case cost per quality adjusted life year gained by using any of the four treatments ranged from pound42 000 ($66 469; (sic) 61 630) to pound98 000 based on efficacy information in the public domain. Uncertainty analysis suggests that the probability of any of these therapies having a cost effectiveness better than pound20 000 is below 20%. The key determinants of cost effectiveness were the time horizon, the progression of patients after stopping treatment, differential discount rates, and the price of the treatments. Conclusions Cost effectiveness varied markedly between the interventions. Uncertainty around point estimates was substantial. This uncertainty could be reduced by conducting research on the true magnitude of the effect of these drugs, the progression of patients after stopping treatment, the costs of care, and the quality of life of the patients. Price was the key modifiable determinant of the cost effectiveness of these treatments.