Mehdi Rezaee1,2, Sadegh Izadi3, Khosro Keshavarz1,4, Afshin Borhanihaghighi3, Ramin Ravangard4. 1. a Department of Health Economics, School of Management and Medical Information Sciences , Shiraz University of Medical Sciences , Shiraz , Iran. 2. b Student Research Committee, School of Management and Medical Information Sciences , Shiraz University of Medical Sciences , Shiraz , Iran. 3. c Clinical Neurology Research Center , Medical School, Shiraz University of Medical Sciences , Shiraz , Iran. 4. d Health Human Resources Research Center, School of Management and Medical Information Sciences , Shiraz University of Medical Sciences , Shiraz , Iran.
Abstract
AIMS: Multiple sclerosis (MS) is a chronic, autoimmune, and inflammatory disease. If the first-line medicines are not effective enough, specialists will prescribe second-line medicines, such as natalizumab and fingolimod. This study aimed to compare the cost-effectiveness and cost-utility of fingolimod with those of natalizumab in patients with relapsing-remitting multiple sclerosis (RRMS) in Iran, Fars province in 2016. MATERIALS AND METHODS: This study was a cost-effectiveness and cost-utility study in which a Markov model was used. The study used the census method to evaluate 81 patients with MS in Iran, Fars province who were being treated with fingolimod and natalizumab. In this study, costs were collected from the societal perspective, and the outcomes were the mean of relapse avoided rate and QALY. The cost data collection form, Kurtzke Expanded Disability Status Scale, and EQ-5D-3L questionnaire were used to collect the required data. RESULTS: The results showed that, compared to natalizumab, patients who used fingolimod had decreased costs (58,087 vs 201,707), increased QALYs (8.09 vs 7.37), and a better relapse avoided rate (6.27 vs 5.83) per patient over the lifetime. The results of the sensitivity analysis showed that the results of the study were robust. Also, the results of the scatter plots showed that fingolimod was more cost-effective based on the QALY and relapse avoided rate in 62% and 56%, respectively, of the simulations for the thresholds below $15,657 for the studied patients. CONCLUSIONS: According to the results of this study, the cost-effectiveness and cost-utility of fingolimod were higher than those of natalizumab. Therefore, it is recommended that treatment with fingolimod be the first priority of second-line treatment for MS patients, and policy-makers and health managers are encouraged to make efforts in order to increase insurance coverage and reduce the out-of-pocket payments of these patients.
AIMS: Multiple sclerosis (MS) is a chronic, autoimmune, and inflammatory disease. If the first-line medicines are not effective enough, specialists will prescribe second-line medicines, such as natalizumab and fingolimod. This study aimed to compare the cost-effectiveness and cost-utility of fingolimod with those of natalizumab in patients with relapsing-remitting multiple sclerosis (RRMS) in Iran, Fars province in 2016. MATERIALS AND METHODS: This study was a cost-effectiveness and cost-utility study in which a Markov model was used. The study used the census method to evaluate 81 patients with MS in Iran, Fars province who were being treated with fingolimod and natalizumab. In this study, costs were collected from the societal perspective, and the outcomes were the mean of relapse avoided rate and QALY. The cost data collection form, Kurtzke Expanded Disability Status Scale, and EQ-5D-3L questionnaire were used to collect the required data. RESULTS: The results showed that, compared to natalizumab, patients who used fingolimod had decreased costs (58,087 vs 201,707), increased QALYs (8.09 vs 7.37), and a better relapse avoided rate (6.27 vs 5.83) per patient over the lifetime. The results of the sensitivity analysis showed that the results of the study were robust. Also, the results of the scatter plots showed that fingolimod was more cost-effective based on the QALY and relapse avoided rate in 62% and 56%, respectively, of the simulations for the thresholds below $15,657 for the studied patients. CONCLUSIONS: According to the results of this study, the cost-effectiveness and cost-utility of fingolimod were higher than those of natalizumab. Therefore, it is recommended that treatment with fingolimod be the first priority of second-line treatment for MSpatients, and policy-makers and health managers are encouraged to make efforts in order to increase insurance coverage and reduce the out-of-pocket payments of these patients.
Authors: Timothy Spelman; William L Herring; Thibaut Dort; Yuanhui Zhang; Michael Tempest; Isobel Pearson; Ulrich Freudensprung; Carlos Acosta; Robert Hyde; Eva Havrdova; Dana Horakova; Maria Trojano; Giovanna De Luca; Alessandra Lugaresi; Guillermo Izquierdo; Pierre Grammond; Pierre Duquette; Raed Alroughani; Eugenio Pucci; Franco Granella; Jeannette Lechner-Scott; Patrizia Sola; Diana Ferraro; Francois Grand'Maison; Murat Terzi; Csilla Rozsa; Cavit Boz; Raymond Hupperts; Vincent Van Pesch; Celia Oreja-Guevara; Anneke van der Walt; Vilija G Jokubaitis; Tomas Kalincik; Helmut Butzkueven Journal: Pharmacoeconomics Date: 2021-12-18 Impact factor: 4.981
Authors: Yazed AlRuthia; Bander Balkhi; Sahar Abdullah Alkhalifah; Salman Aljarallah; Lama Almutairi; Miteb Alanazi; Abdulmalik Alajlan; Suliman M Aldhafiri; Nuha M Alkhawajah Journal: Int J Environ Res Public Health Date: 2021-12-16 Impact factor: 3.390