Cost-Utility Analysis of Intramuscular Interferon Beta-1b Versus Subcutaneous Interferon Beta-1b and Beta-1a in Patients with Relapsing-Remitting Multiple Sclerosis in Colombia

  • Ordoñez J
  • Delgado A
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Abstract

Objectives: To determine cost-utility of interferons intramuscular beta-1-a (IFNbeta -1a-IM), subcutaneous beta-1-a (IFNbeta -1a-SC), subcutaneous beta-1-b (IFNbeta -1b-SC) in patients with Relapsing-Remitting Multiple Sclerosis (RRMS) in Colombia. Methods: The base case patient has a RRMS severity < 2.5 according to Expanded Disability Status Scale, the perspective of analysis was from Colombian health system. Time horizon was 20 years; the annual discount rate was 5% for benefits and costs. Outcomes: proportion of patients without relapses during 24 months, survival rate at 20 years, Quality-Adjusted Life Years (QALYs). Direct costs were calculated for the year 2015. A Markov decision model was constructed in a hypothetical cohort of 1000 patients, considering ten disease' states. The model represents the probabilities of moving from state to state, leaving the treatment and dying. RESULTS : The proportion of patients without relapses are: INFbeta -1a-IM, 34.1%; INFbeta -1a-SC, 23.9%; INFbeta -1b-SC, 13.7%. Most common complications include depression (53%), spasticity (49%) and fatigue (70%). Total discounted costs to 20 years are: no treatment, US$ 40,673; IFNbeta -1a-IM, US$ 147,971; IFNbeta -1a-SC, US$ 179,698; IFNbeta -1b-SC, US$ 141,351. Discounted QALYs to 20 years in 1000 patients are: no treatment, 7,434; IFNbeta -1a-IM, 9,078; IFNbeta -1a-SC, 8,601; IFNbeta -1b-SC, 8,104. ICER versus no treatment are: IFNbeta -1a-IM, US$ 65,276; IFNbeta -1a-SC, US$ 119,188; IFNbeta -1b-SC, US$ 150,419. Survival rates to 20 years are: no treatment, 68.3%; IFNbeta -1a- IM, 89.5%; IFNbeta -1a-SC, 84.2%; IFNbeta -1b-SC, 77.7%. With a willingness to pay higher than US$ 60,000, IFNbeta -1a-IM has a probability higher than 80% to be the chosen treatment, for lower values, the highest probability is no treatment strategy. In the univariate sensitivity analysis, IFNbeta -1a-IM is dominant over IFNbeta -1a-SC in all scenarios of costs, and IFNbeta -1a-IM is dominant over IFNbeta -1b-SC consideringthe minimum cost. CONCLUSIONS: IFNbeta -1a-IM is the most cost-effective strategy in patients with RRMS, both in terms of improved survival and long term QALYs as well as in terms of lowest ICER.

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Ordoñez, J., & Delgado, A. (2016). Cost-Utility Analysis of Intramuscular Interferon Beta-1b Versus Subcutaneous Interferon Beta-1b and Beta-1a in Patients with Relapsing-Remitting Multiple Sclerosis in Colombia. Value in Health, 19(3), A63. https://doi.org/10.1016/j.jval.2016.03.204

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