Cost–effectiveness of natalizumab in multiple sclerosis: an updated systematic review

Abstract

As natalizumab (Tysabri^®; Elan Pharmaceuticals, Inc., Dublin, Ireland) and other disease-modifying drugs are entering the market for multiple sclerosis, the treatment repertoire is expanding beyond the established first-line treatments. This is creating new opportunities but also increasing the uncertainty in the appropriate management of this condition with its considerable societal burden. As a result, economic evaluations are increasingly influential in healthcare decision making. Seven evaluations that included natalizumab have been published to date. They largely report favorable results for this treatment compared with other drugs. However, the models used to reach these conclusions have been subjected to significant debate, owing to limited data availability as well as the methodological complexities and uncertainties in the pharmacoeconomics of multiple sclerosis. This review critically discusses the available evidence based on the cost–effectiveness of natalizumab and uses the data to explain more general issues in the evaluation of similar drugs. The review also suggests how shortcomings in current studies may potentially be addressed in the future.

Keywords::

• cost–effectiveness
• disease-modifying therapies
• expanded disability status scale
• multiple sclerosis
• natalizumab
• utility

Acknowledgements

The authors gratefully acknowledge the help of Gry Wester in the translation of one of the studies. For their comments on earlier drafts of this review, the authors would also like to thank two anonymous reviewers and members of the Centre for the Economics of Mental and Physical Health.

Financial & competing interest disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.