Universitat de Barcelona , Barcelona , Spain.
J Med Econ. 2014 Mar;17(3):215-22. doi: 10.3111/13696998.2014.890936.
To assess the cost-effectiveness of the Disease Modifying Treatments (DMT), Glatiramer Acetate (GA) and Interferon beta-1a (IFN) in monotherapy alone and in combination for the prevention of relapses among Spanish patients aged between 18-60 years old with established Relapsing-Remitting Multiple Sclerosis (RRMS).
A Markov model was developed to represent the transition of a cohort of patients over a 10 year period using the perspective of the Spanish National Health Service (NHS). The model considered five different health states with 1-year cycles including without relapse, patients with suspect, non-protocol defined and protocol defined exacerbations, as well as a category information lost. Efficacy data was obtained from the 3-year CombiRx Study. Costs were reported in 2013 Euros and a 3% discount rate was applied for health and benefits. Deterministic results were presented as the annual treatment cost for the number of relapses. A probabilistic sensitivity analysis was performed to test the robustness of the model.
Deterministic results showed that the expected annual cost per patient was lower when treated with GA (€13,843) compared with IFN (€15,589) and the combined treatment with IFN+GA (€21,539). The annual number of relapses were lower in the GA cohort with 3.81 vs 4.18 in the IFN cohort and 4.08 in the cohort treated with IFN+GA. Results from probabilistic sensitivity analysis showed that GA has a higher probability of being cost-effective than treatment with IFN or IFN+GA for threshold values from €28,000 onwards, independent of the maximum that the Spanish NHS is willing to pay for avoiding relapses.
GA was shown to be a cost-effective treatment option for the prevention of relapses in Spanish patients diagnosed with RRMS. When GA in monotherapy is compared with INF in monotherapy and IFN+GA combined, it may be concluded that the first is the dominant strategy.
评估疾病修正治疗（DMT），醋酸格拉替雷（GA）和干扰素β-1a（IFN）单独和联合用于预防已确诊的复发缓解型多发性硬化症（RRMS）的 18-60 岁西班牙患者复发的成本效益。
使用西班牙国家卫生服务（NHS）的观点，开发了一个马尔可夫模型来代表患者队列在 10 年内的过渡。该模型考虑了五种不同的健康状态，每个状态有 1 年的周期，包括无复发、疑似、非方案定义和方案定义的恶化，以及信息丢失类别。疗效数据来自 3 年的 CombiRx 研究。成本以 2013 年欧元报告，并对健康和收益应用了 3%的贴现率。确定性结果以每例患者的复发年治疗成本表示。进行了概率敏感性分析以测试模型的稳健性。
确定性结果表明，与 IFN（€15589）和 IFN+GA（€21539）联合治疗相比，GA（€13843）治疗的患者预期年度人均成本较低。GA 队列的年复发次数较低，为 3.81 次，IFN 队列为 4.18 次，IFN+GA 队列为 4.08 次。概率敏感性分析结果表明，对于从€28000 起的阈值值，GA 比 IFN 或 IFN+GA 更有可能具有成本效益，这与西班牙 NHS 愿意为避免复发而支付的最高金额无关。
GA 被证明是预防西班牙 RRMS 患者复发的一种具有成本效益的治疗选择。当 GA 单药治疗与 IFN 单药治疗和 IFN+GA 联合治疗相比时，可以得出结论，第一种是主导策略。
