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Cost-Effectiveness Analysis of Alternative Therapies in non-primary progressive Multiple Sclerosis
Available online at www.sciencedirect.com
Research in Social and Administrative Pharmacy 7 (2011) e1–e14
Abstracts from the Midwest Social and Administrative Pharmacy Conference, Iowa City, IA, USA, July 29, 2010 Cost-Effectiveness Analysis of Alternative Therapies in non-primary progressive Multiple Sclerosis Ahmed M. Soliman1, Karen M. Kuntz2, Angeline M. Carlson3, 1,3University of Minnesota, Department of Pharmaceutical Care and Health Systems, 2University of Minnesota, School of Public Health Objective: To assess the cost-effectiveness of three treatment strategies in patients diagnosed with nonprimary progressive multiple sclerosis: 1) symptomatic management alone, 2) symptomatic management combined with Glatiramer Acetate, and 3) symptomatic management combined with subcutaneous Interferon beta 1-a. Methods: We developed a Markov model in which patients transition among health states based on the Kurtzke Expanded Disability Status Scale (EDSS). Patient health status was classified into EDSS 0-2.5, EDSS 3-5.5, EDSS 6-7.5, EDSS 8-9.5 and EDSS 10, which is death. Baseline relapse rates and disease progression transition probabilities were obtained from previously published clinical studies. Treatment effects of the immunomodulatory therapy -which included a reduction in the rate of disease progression as well as reduction in the relapse rate- were determined from published clinical trials and adjusted for discontinuation rates of the medications. Transitions among health states occurred in one-month cycles for a period of 50 years. Costs included direct costs only (cost of acquiring the drugs and cost of treating the relapses). Qualityadjusted life years (QALYs) was used as the unit of effectiveness. Both costs (2009 US$) and outcomes were discounted at an annual rate of 3%. A number of the model assumptions were varied and the effect of such modifications was examined. Results: Glatiramer Acetate produced the largest gain in QALYs with an incremental cost-effectiveness ratio of $483,790/QALY compared with symptomatic management alone. Interferon beta 1-a was more costly and less effective than a combination of the other two strategies and thus was not considered cost-effective. Sensitivity analyses demonstrated that results were sensitive to changes in health-state utilities, disease progression rates, time horizon, and costs of medications. Conclusion: Consistent with previously reported results, both treatments seem to be more effective than symptomatic management alone in treating non-primary progressive multiple sclerosis although they do cost more. Even the most optimistic assumptions did not
yield cost-effectiveness values that were below the incremental cost-effectiveness ratios of other well-accepted medical interventions. This study highlights the need for further research in exploring how those treatments would compare in terms of cost and effectiveness in head-to-head randomized clinical trials. In addition, long term follow-up studies would be beneficial in validating the assumptions regarding the long term benefits of immunomodulatory therapy.
Quantifying the relationship between Involvement and Concern Belief for Osteoarthritis and Hypertension Erin. E. Thatcher, Karen B. Farris, College of Pharmacy, University of Iowa Objective: Those who have a high concern about the prescription medications they are taking may desire more complex medication safety information. The objective of this pilot study was to determine if how the concern belief measure is related to an individual’s level of involvement with hypertension and osteoarthritis. Methods: Study Design: Online survey with a sample of older adults. Subjects: Study population was sample (n¼250) from the Seniors Together in Aging Research (STAR) volunteer registry, a University of Iowa registry of persons aged 50 and older. Half of the subjects recruited had arthritis and half had hypertension. Data collection: The following measures were collected between March 1 and March 29, 2010: demographics, Involvement and Concern Belief for the translated osteoarthritis messages. Analysis: Involvement and concern belief were categorized. Associations of these independent variables against message preference were examined via chi-square test and Spearman correlation. Results: Seventy-five usable surveys were obtained. The majority of subjects were female (N¼47; 70.1%), on average 67.3 years (SD¼ 5.87), White (N¼63; 95.5%) and had attained at least a high school diploma (N¼43; 61.4%). The majority of the subjects had high concern belief for hypertension (66.7%) and osteoarthritis (88.9%). 55.7% of subjects were involved with osteoarthritis and 65.7% with hypertension. Osteoarthritis Involvement was significantly correlated with hypertension involvement. Conclusion: The majority of subjects had high concern for their hypertension and osteoarthritis medications.
1551-7411/$ - see front matter Ó 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.sapharm.2010.09.007
Research in Social and Administrative Pharmacy 7 (2011) e1–e14
Abstracts from the Midwest Social and Administrative Pharmacy Conference, Iowa City, IA, USA, July 29, 2010 Cost-Effectiveness Analysis of Alternative Therapies in non-primary progressive Multiple Sclerosis Ahmed M. Soliman1, Karen M. Kuntz2, Angeline M. Carlson3, 1,3University of Minnesota, Department of Pharmaceutical Care and Health Systems, 2University of Minnesota, School of Public Health Objective: To assess the cost-effectiveness of three treatment strategies in patients diagnosed with nonprimary progressive multiple sclerosis: 1) symptomatic management alone, 2) symptomatic management combined with Glatiramer Acetate, and 3) symptomatic management combined with subcutaneous Interferon beta 1-a. Methods: We developed a Markov model in which patients transition among health states based on the Kurtzke Expanded Disability Status Scale (EDSS). Patient health status was classified into EDSS 0-2.5, EDSS 3-5.5, EDSS 6-7.5, EDSS 8-9.5 and EDSS 10, which is death. Baseline relapse rates and disease progression transition probabilities were obtained from previously published clinical studies. Treatment effects of the immunomodulatory therapy -which included a reduction in the rate of disease progression as well as reduction in the relapse rate- were determined from published clinical trials and adjusted for discontinuation rates of the medications. Transitions among health states occurred in one-month cycles for a period of 50 years. Costs included direct costs only (cost of acquiring the drugs and cost of treating the relapses). Qualityadjusted life years (QALYs) was used as the unit of effectiveness. Both costs (2009 US$) and outcomes were discounted at an annual rate of 3%. A number of the model assumptions were varied and the effect of such modifications was examined. Results: Glatiramer Acetate produced the largest gain in QALYs with an incremental cost-effectiveness ratio of $483,790/QALY compared with symptomatic management alone. Interferon beta 1-a was more costly and less effective than a combination of the other two strategies and thus was not considered cost-effective. Sensitivity analyses demonstrated that results were sensitive to changes in health-state utilities, disease progression rates, time horizon, and costs of medications. Conclusion: Consistent with previously reported results, both treatments seem to be more effective than symptomatic management alone in treating non-primary progressive multiple sclerosis although they do cost more. Even the most optimistic assumptions did not
yield cost-effectiveness values that were below the incremental cost-effectiveness ratios of other well-accepted medical interventions. This study highlights the need for further research in exploring how those treatments would compare in terms of cost and effectiveness in head-to-head randomized clinical trials. In addition, long term follow-up studies would be beneficial in validating the assumptions regarding the long term benefits of immunomodulatory therapy.
Quantifying the relationship between Involvement and Concern Belief for Osteoarthritis and Hypertension Erin. E. Thatcher, Karen B. Farris, College of Pharmacy, University of Iowa Objective: Those who have a high concern about the prescription medications they are taking may desire more complex medication safety information. The objective of this pilot study was to determine if how the concern belief measure is related to an individual’s level of involvement with hypertension and osteoarthritis. Methods: Study Design: Online survey with a sample of older adults. Subjects: Study population was sample (n¼250) from the Seniors Together in Aging Research (STAR) volunteer registry, a University of Iowa registry of persons aged 50 and older. Half of the subjects recruited had arthritis and half had hypertension. Data collection: The following measures were collected between March 1 and March 29, 2010: demographics, Involvement and Concern Belief for the translated osteoarthritis messages. Analysis: Involvement and concern belief were categorized. Associations of these independent variables against message preference were examined via chi-square test and Spearman correlation. Results: Seventy-five usable surveys were obtained. The majority of subjects were female (N¼47; 70.1%), on average 67.3 years (SD¼ 5.87), White (N¼63; 95.5%) and had attained at least a high school diploma (N¼43; 61.4%). The majority of the subjects had high concern belief for hypertension (66.7%) and osteoarthritis (88.9%). 55.7% of subjects were involved with osteoarthritis and 65.7% with hypertension. Osteoarthritis Involvement was significantly correlated with hypertension involvement. Conclusion: The majority of subjects had high concern for their hypertension and osteoarthritis medications.
1551-7411/$ - see front matter Ó 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.sapharm.2010.09.007