a Evidera , 430 Bedford St. Suite 300 , Lexington , MA 02420 , USA ;
b Biogen , Landis & Gyr-Strasse 3 , 6300 Zug , Switzerland ;
J Med Econ. 2016 Jul;19(7):684-95. doi: 10.3111/13696998.2016.1157080. Epub 2016 Mar 7.
Objective Peginterferon beta-1a 125 mcg, administered subcutaneously (SC) every 2 weeks, a new disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (RRMS), was approved by the US Food and Drug Administration in 2014. This study assesses the cost-effectiveness of peginterferon beta-1a vs interferon beta-1a (44 mcg SC 3 times per week) and glatiramer acetate (20 mg SC once-daily) in the treatment of RRMS from the perspective of a US payer over 10 years. Methods A Markov cohort economic model was developed for this analysis. The model predicts disability progression, occurrence of relapses and other adverse events and translates them into quality-adjusted life years (QALYs) and costs. Natural history data were obtained from the placebo arm of the ADVANCE trial of peginterferon beta-1a, the London Ontario (Canada) database and a large population-based MS survey. Comparative efficacy of each DMT vs placebo was obtained from a network meta-analysis. Costs (in 2014 US dollars) were sourced from public databases and literature. Clinical and economic outcomes were discounted at 3% per year. Results Over 10 years, peginterferon beta-1a was dominant (i.e., more effective and less costly), with cost-savings of $22,070 and additional 0.06 QALYs when compared with interferon beta-1a 44 mcg and with cost-savings of $19,163 and 0.07 QALYs gained when compared with glatiramer acetate 20 mg. Results were most sensitive to variations in the treatment effect of each DMT, treatment acquisition costs of each DMT and the time horizon. Probabilistic sensitivity analyses indicated that peginterferon beta-1a remains dominant in >90% of 5,000 replications compared with either DMTs. Conclusion This analysis suggests that long-term treatment with peginterferon beta-1a improves clinical outcomes at reduced costs compared with interferon beta-1a 44 mcg and glatiramer acetate 20 mg and should be a valuable addition to managed care formularies for treating patients with RRMS.
聚乙二醇干扰素 beta-1a125mcg，皮下注射（SC）每 2 周一次，是一种新的治疗复发缓解型多发性硬化症（RRMS）的疾病修正疗法（DMT），于 2014 年获得美国食品和药物管理局批准。本研究从美国支付者的角度评估了聚乙二醇干扰素 beta-1a 与干扰素 beta-1a（44mcg SC 每周 3 次）和那他珠单抗（20mg SC 每日 1 次）在治疗 RRMS 方面的成本效益，时间跨度为 10 年。
本分析采用了 Markov 队列经济模型。该模型预测残疾进展、复发和其他不良事件，并将其转化为质量调整生命年（QALYs）和成本。自然史数据来自聚乙二醇干扰素 beta-1a 的 ADVANCE 试验安慰剂组、伦敦安大略省（加拿大）数据库和一项大型基于人群的 MS 调查。每种 DMT 相对于安慰剂的比较疗效来自网络荟萃分析。成本（2014 年美元）来自公共数据库和文献。临床和经济结果按每年 3%贴现。
在 10 年内，聚乙二醇干扰素 beta-1a 具有优势（即更有效且成本更低），与干扰素 beta-1a 44mcg 相比，节省成本 22070 美元，增加 0.06 个 QALY；与那他珠单抗相比，节省成本 19163 美元，增加 0.07 个 QALY。结果对每种 DMT 的治疗效果、每种 DMT 的治疗获得成本和时间范围的变化最为敏感。概率敏感性分析表明，与任何一种 DMT 相比，聚乙二醇干扰素 beta-1a 在 5000 次重复中的>90%仍然具有优势。
本分析表明，与干扰素 beta-1a 44mcg 和那他珠单抗相比，长期使用聚乙二醇干扰素 beta-1a 可改善临床结局，同时降低成本，因此应成为治疗 RRMS 患者的管理式医疗方案的重要补充。
