OBJECTIVES: To assess, from a Swedish societal perspective, the cost effectiveness of interferon β-1b (IFNB-1b) after an initial clinical event suggestive of multiple sclerosis (MS) (ie, early treatment) compared with treatment after onset of clinically definite MS (CDMS) (ie, delayed treatment).
METHODS: A Markov model (clever statistics using gaming theory) was developed, using MSer level data from the BENEFIT trial (CIS study of
IFNB-1b) and published literature, to estimate health outcomes and costs associated with IFNB-1b for hypothetical cohorts of MSers after an initial clinical event suggestive of MS (CIS). Health states were defined by Kurtzke Expanded Disability Status Scale (EDSS) scores. Model outcomes included quality-adjusted life years (QALYs), total costs (including both direct and indirect costs), and incremental cost-effectiveness ratios. Sensitivity analyses were performed on key model parameters to assess the robustness of model results.
RESULTS: In the base case scenario, early IFNB-1b treatment was economically dominant (ie, less costly and more effective) versus delayed IFNB-1b treatment when QALYs were used as the effectiveness metric. Sensitivity analyses showed that the cost-effectiveness results were sensitive to model time horizon. Compared with the delayed treatment strategy, early treatment of MS was also associated with delayed EDSS progressions, prolonged time to CDMS diagnosis, and a reduction in frequency of relapse.
CONCLUSION: Early treatment with IFNB-1b for a first clinical event suggestive of MS was found to improve patient outcomes while controlling costs
“I suspect that the new generation DMTs, that are more effective than IFNB-1b, are going to push these lines even further to the right, i.e. have a greater impact on survival. There is little doubt in my mind that early, aggressive, treatment is the answer. Data from this model supports it. This strategy has cost saving benefits in relation to healthcare and social needs in the long-term. Importantly, NICE do not include the latter in their models. Keeping MSers employed, married and without the need for carers is not of interest to NICE; all they are concerned about is how much it costs to the NHS (direct costs). Social care costs do not register on the NHS’s bottom line. I can imagine a very effective drug, for example Alemtuzumab, that may be very expensive up front not getting the green light from NICE because the direct costs are too high. Another problem we also have to face is that the risks associated with these more effective treatments are considered by many to be too great to use them early. These risk-averse individuals are keen to wait for MSers to have more active disease before escalating their treatment. The problem with the latter strategy is that as you wait for your disease to become more active the ongoing damage caused may be irreversible. Please remember irreversible damage does not have to relate to physical disability, but as we have said many times before on this blog it could be cognitive.”