Brown M G, Murray T J, Sketris I S, Fisk J D, LeBlanc J C, Schwartz C E, Skedgel C
Dalhousie University.
Int J Technol Assess Health Care. 2000 Summer;16(3):751-67. doi: 10.1017/s026646230010203x.
To estimate the cost-effectiveness (CE) of interferon beta-1b (IFN beta-1b) in slowing disability progression in persons with relapsing-remitting multiple sclerosis (RRMS).
Treatment program costs and health outcomes are modeled for cohorts of 1,000 females and 1,000 males followed 40 years from onset. Fifteen scenarios model MS natural history progression, treatment efficacy, direct treatment costs, and MS healthcare costs. A single randomized placebo-controlled trial of IFN beta-1b found reduced disease activity by MRI, reduced frequency and severity of exacerbations, and a tendency toward slower disability progression. Disability years avoided are modeled as the primary health outcome analyzed. A ministry of health (MOH) perspective is adopted, using Nova Scotia population-based data. Annual IFN beta-1b direct treatment costs (Can $16,685) are high relative to both MOH healthcare costs per person with MS (Can $2,000) and estimated MOH costs avoided.
Given "reference case" assumptions for women with RRMS, treatment reduces lifetime disability years by 10%. Cost per disability year avoided before discounting is Can $189,230 (US $124,892), and Can $274,842 (US $181,395) after discounting at 5%. Estimates for alternative scenarios vary greatly, leaving main findings unchanged.
Using the Expanded Disability Status Scale, cost per disability year avoided due to interferon beta-1b treatment in RRMS is quite high. Comparable CE estimates, using MS-specific or generic health-related quality-of-life outcome measures, are even higher. Further research is required to better measure treatment effects, modification of MS natural history, and net societal costs of IFN beta-1b in RRMS.
评估β-1b干扰素（IFNβ-1b）在延缓复发缓解型多发性硬化症（RRMS）患者残疾进展方面的成本效益（CE）。
对1000名女性和1000名男性患者从发病起随访40年的队列进行治疗方案成本和健康结果建模。15种情景模拟了MS自然病史进展、治疗效果、直接治疗成本和MS医疗保健成本。一项关于IFNβ-1b的单一随机安慰剂对照试验发现，MRI显示疾病活动减少，病情加重的频率和严重程度降低，且有残疾进展放缓的趋势。避免的残疾年数被建模为分析的主要健康结果。采用基于新斯科舍省人群数据的卫生部（MOH）视角。相对于MOH为每位MS患者的医疗保健成本（2000加元）和估计避免的MOH成本，IFNβ-1b的年度直接治疗成本（16685加元）较高。
对于RRMS女性患者，在“参考案例”假设下，治疗可使终身残疾年数减少10%。贴现前避免的每残疾年成本为189230加元（124892美元），5%贴现后为274842加元（181395美元）。替代情景的估计差异很大，但主要结果不变。
使用扩展残疾状态量表，RRMS中因β-1b干扰素治疗而避免的每残疾年成本相当高。使用特定于MS或通用的健康相关生活质量结果测量方法得出的可比CE估计值甚至更高。需要进一步研究以更好地衡量RRMS中IFNβ-1b的治疗效果、对MS自然病史的改变以及净社会成本。
