Cost-utility analysis of multiple sclerosis rehabilitation in Iran

ABSTRACT

Background

Rehabilitation of Multiple Sclerosis (MS) is associated with various clinical, social and economic outcomes. We aimed to evaluate the cost-utility of MS multidisciplinary rehabilitation in Iran.

Research design and methods

An economic evaluation was conducted using a Markov model designed to reflect the natural course of the disease and interventions. Parameters and variables were extracted from available evidence, and costs and outcomes were calculated from the social perspective. The base-case analysis considered a 5-year time horizon. Costs were estimated based on approved national standards for MS rehabilitation. Sensitivity analyses were also performed.

Results

The average cost of the rehabilitation strategy was higher compared to the non-rehabilitation strategy, but it resulted in higher quality-adjusted life years (QALYs) values. The incremental cost-effectiveness ratio (ICER) was found to be $2,845.8 per QALY, indicating that the rehabilitation strategy is cost-effective. In the deterministic sensitivity analysis, extending the time horizon to 10 years made the rehabilitation strategy a dominant choice. Probabilistic sensitivity analysis results were consistent with the base-case findings.

Conclusions

The MS multidisciplinary rehabilitation proved to be a cost-effective strategy; however, the results were sensitive to the input values of the model. Increasing the time horizon increased the probability of rehabilitation being cost-effective.

KEYWORDS:

• Multiple sclerosis (MS)
• rehabilitation
• economic evaluation
• cost-utility
• cost-effectiveness

Acknowledgments

This research is a part of a project carried out with the support of the Rehabilitation Consultant Office of the Iran’s Ministry of Health, Treatment and Medical Education and the University of Rehabilitation Sciences and Social Health.

Author contributions

Conception and design: Rajabali Daroudi, Ali Darvishi, Mirtaher Mousavi, Marzieh Shirazikhah

Analysis and interpretation of the data: Ali Darvishi, Mirtaher Mousavi, Marzieh Shirazikhah, Mehdi Alizadeh Zarei, Hamidreza Hendi, Faezeh Joghataei

Drafting of the paper: Ali Darvishi, Hamidreza Hendi, Faezeh Joghataei

Revising the paper critically: Ali Darvishi, Mirtaher Mousavi, Marzieh Shirazikhah, Mehdi Alizadeh Zarei, Hamidreza Hendi, Faezeh Joghataei

The final approval of the version to be published: Rajabali Daroudi

Declaration of interest

All the authors declare that there is no conflict of interest.

Additional information

Funding

This paper was not funded.