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Modeling the cost-effectiveness of a new treatment for MS (natalizumab) compared with current standard practice in Sweden.

Kobelt, Gisela LU ; Berglund, Johan; Lindgren, P; Jonsson, B; Stawiarz, L and Hillert, J (2008) In Multiple Sclerosis 14(5). p.679-690
Abstract
Objective To estimate the cost-effectiveness of a new treatment (natalizumab) for multiple sclerosis (MS) compared with current standard therapy with disease-modifying drugs (DMDs) in Sweden. Methods A Markov model was constructed to illustrate disease progression based on functional disability (the Expanded Disability Status Scale (EDSS)). The effectiveness of natalizumab was based on a 2-year clinical trial in 942 patients (AFFIRM). The effectiveness of current DMDs was estimated from a matched sample of 512 patients in the Stockholm MS registry. Patients withdrawing from treatment were assumed to follow the disease course of 824 patients with relapsing-remitting disease at onset in the Ontario natural history cohort. Costs and utilities... (More)
Objective To estimate the cost-effectiveness of a new treatment (natalizumab) for multiple sclerosis (MS) compared with current standard therapy with disease-modifying drugs (DMDs) in Sweden. Methods A Markov model was constructed to illustrate disease progression based on functional disability (the Expanded Disability Status Scale (EDSS)). The effectiveness of natalizumab was based on a 2-year clinical trial in 942 patients (AFFIRM). The effectiveness of current DMDs was estimated from a matched sample of 512 patients in the Stockholm MS registry. Patients withdrawing from treatment were assumed to follow the disease course of 824 patients with relapsing-remitting disease at onset in the Ontario natural history cohort. Costs and utilities are based on a recent observational study in 1339 patients. All data sets were available at the patient level. Main results are presented from the societal perspective, over a 20-year time frame, in 2005 Euros (euro1 = 9.25 SEK). Results In the base case, treatment with natalizumab was less expensive and more effective than treatment with current DMDs. When only healthcare costs were considered, the cost per quality-adjusted life year gained with natalizumab was euro38 145. Results are sensitive only to the time horizon of the analysis and assumptions about effectiveness of natalizumab beyond the trial. Conclusions This cost-effectiveness analysis used registry data, cohort and observational studies to extrapolate the efficacy findings of natalizumab from the AFFIRM clinical trial to measure effectiveness in clinical practice. The analysis results suggest that for the population considered, natalizumab provides an additional health benefit at a similar cost to current DMDs from a societal perspective. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Multiple Sclerosis
volume
14
issue
5
pages
679 - 690
publisher
Arnold, Hodder Headline PLC
external identifiers
  • wos:000256882200013
  • pmid:18566030
  • scopus:46849108700
ISSN
1477-0970
DOI
10.1177/1352458507086667
language
English
LU publication?
yes
id
412f4217-ce71-4274-87fa-056bda70d06a (old id 1168668)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18566030?dopt=Abstract
date added to LUP
2008-07-04 10:01:12
date last changed
2017-10-01 04:54:58
@article{412f4217-ce71-4274-87fa-056bda70d06a,
  abstract     = {Objective To estimate the cost-effectiveness of a new treatment (natalizumab) for multiple sclerosis (MS) compared with current standard therapy with disease-modifying drugs (DMDs) in Sweden. Methods A Markov model was constructed to illustrate disease progression based on functional disability (the Expanded Disability Status Scale (EDSS)). The effectiveness of natalizumab was based on a 2-year clinical trial in 942 patients (AFFIRM). The effectiveness of current DMDs was estimated from a matched sample of 512 patients in the Stockholm MS registry. Patients withdrawing from treatment were assumed to follow the disease course of 824 patients with relapsing-remitting disease at onset in the Ontario natural history cohort. Costs and utilities are based on a recent observational study in 1339 patients. All data sets were available at the patient level. Main results are presented from the societal perspective, over a 20-year time frame, in 2005 Euros (euro1 = 9.25 SEK). Results In the base case, treatment with natalizumab was less expensive and more effective than treatment with current DMDs. When only healthcare costs were considered, the cost per quality-adjusted life year gained with natalizumab was euro38 145. Results are sensitive only to the time horizon of the analysis and assumptions about effectiveness of natalizumab beyond the trial. Conclusions This cost-effectiveness analysis used registry data, cohort and observational studies to extrapolate the efficacy findings of natalizumab from the AFFIRM clinical trial to measure effectiveness in clinical practice. The analysis results suggest that for the population considered, natalizumab provides an additional health benefit at a similar cost to current DMDs from a societal perspective.},
  author       = {Kobelt, Gisela and Berglund, Johan and Lindgren, P and Jonsson, B and Stawiarz, L and Hillert, J},
  issn         = {1477-0970},
  language     = {eng},
  number       = {5},
  pages        = {679--690},
  publisher    = {Arnold, Hodder Headline PLC},
  series       = {Multiple Sclerosis},
  title        = {Modeling the cost-effectiveness of a new treatment for MS (natalizumab) compared with current standard practice in Sweden.},
  url          = {http://dx.doi.org/10.1177/1352458507086667},
  volume       = {14},
  year         = {2008},
}