ALS/MND and the perspective of health economics.

In health care, choices are constantly being made about alternative uses of scarce resources, and health economics offers a framework for analysing these choices and for improving resource allocation. In cost-effectiveness analysis, the costs and consequences of alternatives are systematically measured and compared, with the objective of achieving maximum health gain with the available resources. Treatment options for patients with ALS/MND are severely limited, but riluzole has been shown to offer modest improvements in survival. However, decision-makers are likely to want convincing evidence on the cost-effectiveness of this therapy before recommending widespread adoption. Here, some initial estimates of cost-effectiveness are provided, using published effectiveness data and considering only the costs of therapy and of tracheostomy. Compared with placebo, the incremental cost per life year gained of 50 mg/day of riluzole is pound sterling 45630, and of 100 mg/day is pound sterling 44890. Increasing the estimated costs of tracheostomy reduces the cost per life year gained of 50 mg/day to pound sterling 34940. However, if quality of life during the increased period of survival is 80% of full health, the cost per quality adjusted life year gained of 50 mg/day becomes pound sterling 57040. These cost-effectiveness ratios are well in excess of the range that is normally considered to be acceptable in UK health technology assessment. However, the comparatively small number of ALS/MND patients and the lack of treatment alternatives should also be considered. Meanwhile, better information on costs is required in order to produce more precise estimates of cost-effectiveness.