Wan George J, Chopra Ishveen, Niewoehner John, Hunter Samuel F
Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA.
Manticore Consultancy, Bethesda, MD, USA.
Drugs Context. 2020 Dec 16;9. doi: 10.7573/dic.2020-9-4. eCollection 2020.
Relapses are common in patients with multiple sclerosis (MS) even after the use of disease-modifying therapies. Repository corticotropin injection (RCI), plasmapheresis (PMP), and intravenous immunoglobulin (IVIg) may be utilized as alternative therapies in the management of MS relapse. There is a lack of health economic studies on these alternative therapies for the acute exacerbations of MS. The objective of this study was to estimate the cost per response of RCI compared with PMP or IVIg from the United States (US) commercial payer perspective.
Costs and response rates were sourced from published peer-reviewed observational studies. The cost of care included MS-related inpatient, outpatient, and medication costs. Treatment response was defined as no evidence of additional relapse treatment or procedure claims within 30 days after treatment. The cost per response for each treatment was calculated by dividing the total annual cost of care by the proportion of patients with resolved relapse for each treatment. The incremental cost per response ratio was calculated by dividing the difference in costs and the proportion of responses for RCI PMP or IVIg. One-way sensitivity analysis (OWSA) was conducted for both costs and response rates. All included costs were inflated to the 2019 US dollars.
With a lower total annual cost of care and a higher response rate, RCI had a lower cost per response (US$141,970) compared with PMP or IVIg (US$253,331). RCI had a lower cost per response even when more stringent estimates for RCI were applied in the OWSA. The annual cost of care had a greater influence on the cost per response in the OWSA.
Based on the estimates from the real-world evidence, our economic evaluation suggests that RCI may have real-world clinical and economic benefits for patients with MS relapse who fail on corticosteroid therapy.
即使使用了疾病修正疗法，多发性硬化症（MS）患者的复发仍很常见。储存库促肾上腺皮质激素注射（RCI）、血浆置换（PMP）和静脉注射免疫球蛋白（IVIg）可作为治疗MS复发的替代疗法。目前缺乏关于这些替代疗法治疗MS急性加重的卫生经济学研究。本研究的目的是从美国商业支付方的角度估计RCI与PMP或IVIg相比的每反应成本。
成本和反应率来自已发表的同行评审观察性研究。护理成本包括与MS相关的住院、门诊和药物成本。治疗反应定义为治疗后30天内无额外复发治疗或程序索赔的证据。每种治疗的每反应成本通过将每年护理总成本除以每种治疗复发缓解患者的比例来计算。每反应增量成本比通过将RCI与PMP或IVIg的成本差异和反应比例相除来计算。对成本和反应率进行了单向敏感性分析（OWSA）。所有纳入的成本均按2019年美元进行了通胀调整。
RCI的每年护理总成本较低且反应率较高，与PMP或IVIg（253,331美元）相比，其每反应成本较低（141,970美元）。即使在OWSA中对RCI应用更严格的估计时，RCI的每反应成本也较低。在OWSA中，每年护理成本对每反应成本的影响更大。
基于真实世界证据的估计，我们的经济评估表明，对于皮质类固醇治疗失败的MS复发患者，RCI可能具有真实世界的临床和经济效益。
