Population based cost utility study of interferon beta-1b in secondary progressive multiple sclerosis

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Abstract
Objective: To evaluate the cost utility of interferon beta-1b in secondary progressive multiple sclerosis. Design: Population based cost utility model (healthcare perspective). Data on use of health services were obtained from case records and routine morbidity data and utility values from a EuroQol survey. Local and published costs were used. Effectiveness was modelled using data on relative risk reductions from a randomised trial of interferon beta-1b. Setting: Tayside region, 1993-5. Subjects: 132 ambulatory people with secondary progressive multiple sclerosis. Main outcome measures: Cost per quality adjusted life year (QALY) gained. Rate of relapse and proportion becoming wheelchair dependent over three years. Results: The number needed to treat for 30 months to delay time to wheelchair dependence in one person by nine months was 18 (95% confidence interval 5 to 26). For every 18 people treated for 30 months, six relapses would be prevented, gaining 0.397 discounted QALYs. The cost per QALY gained was £1 024 667 (£276 466 to £1 485 499). If treatment was restricted to patients attending neurology services, the number needed to treat was 14 (cost per QALY gained £833 514 (£161 358 to ∞)). The cost per QALY gained was not sensitive to changes in cost which took account of a societal perspective. Conclusions: The cost per QALY gained from interferon beta is high because of the high drug cost and modest clinical effect. Resources could be used more efficiently elsewhere. Secondary progressive multiple sclerosis is a potentially disabling disorder associated with low health related quality of life Interferon beta-1b may reduce rate of relapse The benefits of interferon beta-1b treatment are very low relative to its cost Cost utility analysis estimated a cost of over £1m per QALY gained Cost per QALY was not affected by taking into account the costs of care Money would be better spent on other ways of improving quality of life than on interferon beta