The following is a summary of “Untackling the economics of Multiple Sclerosis: a systematic review of economic evaluations of disease-modifying therapies indicated for Multiple Sclerosis,” published in the November 2024 issue of Neurology by Petrou et al.    

Worldwide, approximately 2.8 million people are affected by multiple sclerosis (MS) and have chronic, neurodegenerative disease. Manageable with various disease-modifying therapies (DMTs), though coming with high costs and uncertainty.  

Researchers conducted a retrospective study assessing the cost-effectiveness of DMTs therapies for MS.  

They reviewed studies on adult patients with any form of MS receiving any DMT (2000 and 2023). The outcomes were incremental cost-utility ratios (ICUR) and cost-effectiveness ratios (ICER). The methodological quality of the studies was assessed using the Quality of Health Economic Studies (QHES) tool.  

The results showed 57 studies met the inclusion criteria, spanning 20 countries. A substantial level of findings was observed, influenced by country setting, study perspective (social vs. healthcare), selection of benchmark treatments, data extrapolation beyond trial timeframes, and model time horizons. Dimethyl fumarate (DMF) and fampridine were consistently associated with positive cost-effectiveness ratios. Cladribine was identified as a dominating agent. Ocrelizumab also demonstrated cost-effectiveness. Early data for Siponimod and ofatumumab showed promising results. Interferons showed inefficiency and introduced complications when used as a benchmark for cost comparisons. The results for fingolimod and natalizumab were surrounded by uncertainty. Earlier access to therapies correlated positively with better cost-effectiveness outcomes. Results were sensitive to several factors, including the products’ effectiveness and the agents’ cost. Utility values, study time horizon, and efficacy waning also played key roles in influencing cost-effectiveness. The efficiency of therapies varied depending on the type of MS.  

They concluded that while there is an increasing body of evidence on the economic evaluations of DMTs for MS, the results could have been more consistent due to varying methodologies and influencing factors.  

Source: msard-journal.com/article/S2211-0348(24)00737-5/abstract