Hunter Samuel F, Bindra Jas, Chopra Ishveen, Niewoehner John, Panaccio Mary P, Wan George J
Advanced Neurosciences Institute, Franklin, TN, USA.
Falcon Research Group, North Potomac, MD, USA.
Clinicoecon Outcomes Res. 2021 Oct 11;13:883-892. doi: 10.2147/CEOR.S330118. eCollection 2021.
Relapses are common among patients with multiple sclerosis (MS) despite treatment with disease-modifying therapies. Repository corticotropin injection (RCI, Acthar Gel), plasmapheresis (PMP), and intravenous immunoglobulin (IVIg) are alternative therapies for MS relapse. There is a dearth of economic assessments of these therapies for the acute exacerbations of MS. This study estimated the cost-effectiveness of RCI compared to PMP or IVIg.
A Markov state-transition model compared outcomes (costs, relapses, remission, and utilities) with RCI versus PMP or IVIg for the acute exacerbations in MS. The model was developed from the United States (US) payer and societal perspectives over one to three years. Patients initiated on alternative therapies were evaluated in one-day increments for the first 30 days during treatment. The model assumes the natural history of MS after treatment in the first month, adjusting for the effect of treatment. Incremental cost-effectiveness ratios (ICERs) were estimated as cost per quality-adjusted life-year (QALY) gained. The uncertainty in model parameters was evaluated in probabilistic sensitivity analyses.
In the base case, RCI has an ICER of USD 42,078 per QALY compared to PMP over one year from the payer perspective and is dominant over two and three years; RCI is dominant compared to PMP from the societal perspective over all three years. Compared to IVIg, RCI is a dominant strategy from both payer and societal perspectives over all three years. Probabilistic sensitivity analysis supports the base case findings, suggesting that RCI may be cost-effective versus PMP and IVIg for acute exacerbations in MS.
RCI is a cost-effective alternative treatment for MS relapses compared to PMP and IVIg from the US payer and societal perspectives.
尽管接受了疾病修正治疗，但多发性硬化症（MS）患者的复发仍很常见。储存促肾上腺皮质激素注射液（RCI，促皮质素凝胶）、血浆置换（PMP）和静脉注射免疫球蛋白（IVIg）是治疗MS复发的替代疗法。对于MS急性加重期的这些疗法，缺乏经济评估。本研究估计了RCI与PMP或IVIg相比的成本效益。
采用马尔可夫状态转换模型比较了RCI与PMP或IVIg治疗MS急性加重期的结果（成本、复发、缓解和效用）。该模型是从美国支付方和社会角度在1至3年内建立的。开始接受替代疗法的患者在治疗的前30天按每天增量进行评估。该模型假设了治疗后第一个月MS的自然病程，并对治疗效果进行了调整。增量成本效益比（ICER）估计为每获得一个质量调整生命年（QALY）的成本。在概率敏感性分析中评估了模型参数的不确定性。
在基础案例中，从支付方角度来看，与PMP相比，RCI在1年内每QALY的ICER为42,078美元，在2年和3年内占主导地位；从社会角度来看，RCI在所有3年中与PMP相比都占主导地位。与IVIg相比，RCI在所有3年中从支付方和社会角度来看都是主导策略。概率敏感性分析支持基础案例的结果，表明对于MS急性加重期，RCI与PMP和IVIg相比可能具有成本效益。
从美国支付方和社会角度来看，与PMP和IVIg相比，RCI是治疗MS复发的一种具有成本效益的替代疗法。
