Alsaqa'aby Mai F, Vaidya Varun, Khreis Noura, Khairallah Thamer Al, Al-Jedai Ahmed H
Mai F. Alsaqa'aby Pharmaceutical Care Division, MBC 11,, King Faisal Specialist Hospital and Research Centre,, PO Box 3354, Riyadh 11211, Saudi Arabia, T: +966-11-216919 loc 38631 MCD: 48112,
Ann Saudi Med. 2017 Nov-Dec;37(6):433-443. doi: 10.5144/0256-4947.2017.433.
Promising clinical and humanistic outcomes are associated with the use of new oral agents in the treatment of relapsing-remitting multiple sclerosis (RRMS). This is the first cost-effectiveness study comparing these medications in Saudi Arabia.
We aimed to compare the cost-effectiveness of fingolimod, teriflunomide, dimethyl fumarate, and interferon (IFN)-b1a products (Avonex and Rebif) as first-line therapies in the treatment of patients with RRMS from a Saudi payer perspective.
Cohort Simulation Model (Markov Model).
Tertiary care hospital.
A hypothetical cohort of 1000 RRMS Saudi patients was assumed to enter a Markov model model with a time horizon of 20 years and an annual cycle length. The model was developed based on an expanded disability status scale (EDSS) to evaluate the cost-effectiveness of the five disease-modifying drugs (DMDs) from a healthcare system perspective. Data on EDSS progression and relapse rates were obtained from the literature; cost data were obtained from King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. Results were expressed as incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMB) in Saudi Riyals and converted to equivalent $US. The base-case willingness-to-pay (WTP) threshold was assumed to be $100000 (SAR375000). One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to test the robustness of the model.
ICERs and NMB.
The base-case analysis results showed Rebif as the optimal therapy at a WTP threshold of $100000. Avonex had the lowest ICER value of $337282/QALY when compared to Rebif. One-way sensitivity analysis demonstrated that the results were sensitive to utility weights of health state three and four and the cost of Rebif.
None of the DMDs were found to be cost-effective in the treatment of RRMS at a WTP threshold of $100000 in this analysis. The DMDs would only be cost-effective at a WTP above $300000.
The current analysis did not reflect the Saudi population preference in valuation of health states and did not consider the societal perspective in terms of cost.
在复发缓解型多发性硬化症（RRMS）治疗中使用新型口服药物可带来良好的临床和人文结局。这是沙特阿拉伯第一项比较这些药物成本效益的研究。
从沙特付款方的角度，比较芬戈莫德、特立氟胺、富马酸二甲酯和干扰素（IFN）-b1a产品（阿沃尼克和利比）作为一线疗法治疗RRMS患者的成本效益。
队列模拟模型（马尔可夫模型）。
三级护理医院。
假设一个由1000名沙特RRMS患者组成的假设队列进入一个时间跨度为20年、每年循环一次的马尔可夫模型。该模型基于扩展残疾状态量表（EDSS）开发，从医疗系统的角度评估五种疾病修正药物（DMD）的成本效益。EDSS进展和复发率的数据来自文献；成本数据来自沙特阿拉伯利雅得的法赫德国王专科医院和研究中心。结果以增量成本效益比（ICER）和净货币效益（NMB）表示，单位为沙特里亚尔，并换算为等值美元。基础案例支付意愿（WTP）阈值假定为100000美元（375000沙特里亚尔）。进行单向敏感性分析和概率敏感性分析以检验模型的稳健性。
ICER和NMB。
基础案例分析结果显示，在支付意愿阈值为100000美元时，利比是最佳疗法。与利比相比，阿沃尼克的ICER值最低，为337282美元/质量调整生命年。单向敏感性分析表明，结果对健康状态三、四的效用权重以及利比的成本敏感。
在此分析中，在支付意愿阈值为100000美元时，未发现任何一种DMD在治疗RRMS方面具有成本效益。只有在支付意愿高于300000美元时，DMD才具有成本效益。
当前分析未反映沙特人群对健康状态估值的偏好，且未从社会角度考虑成本。
