Cost effectiveness of glatiramer acetate and natalizumab in relapsing-remitting multiple sclerosis
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Appl Health Econ Health Policy 2009; 7 (2): 91-108 1175-5652/09/0002-0091/$49.95/0
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Cost Effectiveness of Glatiramer Acetate and Natalizumab in Relapsing-Remitting Multiple Sclerosis Stephanie R. Earnshaw,1 Jonathan Graham,1 MerriKay Oleen-Burkey,2 Jane Castelli-Haley2 and Kenneth Johnson3 1 RTI Health Solutions, Research Triangle Park, North Carolina, USA 2 Teva Neuroscience, Inc., Kansas City, Missouri, USA 3 Maryland Center for Multiple Sclerosis, School of Medicine, University of Maryland, Baltimore, Maryland, USA
Abstract
Background: Disease-modifying drugs are a significant expenditure for treating multiple sclerosis. Natalizumab (NZ) has been shown to be effective in reducing relapses and disease progression. However, assessment of the cost effectiveness of NZ compared with other disease-modifying drugs in the presence of long-term data has been limited. Objective: To assess the lifetime cost effectiveness from the US healthcare and societal perspectives of glatiramer acetate (GA) and NZ (both given with symptom management) relative to symptom management alone in patients with relapsing-remitting multiple sclerosis (RRMS) using evidence from long-term published studies. Methods: A Markov model was developed with patients transitioning through health states based on Kurtzke’s expanded disability status scale (EDSS). Patients were ‡18 years of age with RRMS, EDSS 7.5 were assumed to be negative. As a result, large differences in QALYs were observed among treatments. It is these large differences in QALYs among treatments that cause the cost effectiveness to vary substantially. Although all these issues may have a legitimate effect on a patient’s well-being, it is important to ensure that derivation of the overall effect is accurate when the Appl Health Econ Health Policy 2009; 7 (2)
Glatiramer Acetate and Natalizumab in RRMS
individual components that measure each effect are combined. Overall, the differences in results reported in our analysis compared with results reported by Gani et al.[23] demonstrate a clear need for future studies examining QOL in MS patients. We caution the reader to consider the differences in this and the Gani et al.[23] analysis carefully. As part of this analysis, we recognize a number of limitations. First and foremost is the lack of data on change in clinical efficacy and discontinuation over time for patients receiving NZ. As seen in previous analyses, the cost effectiveness of disease-modifying therapies is very different when long-term clinical effectiveness is not considered. Although year 1 and 2 relative reductions in disease progression and relapse seem to be better in clinical trials for NZ than for GA, consideration of discontinuation and supplementing the pivotal clinical trial data with potential changes in clinical effectiveness from patients enrolled in the prospective clinical trial extension and long-term follow-up improves the outcomes for GA. While an analysis based on the assumption that clinical effecti
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