Cost-effectiveness of glatiramer acetate and interferon beta-1a for relapsing-remitting multiple sclerosis, based on the CombiRx study

Figures & data

Figure 1. Graphic representation of the model.

Table 1. Transition probabilities for the first year; GA and IFN in monotherapy and combined IFN + GA*.

	NR	SE	NPDE	PDE	IL
GA 20 mg
NR	0.567	0.123	0.138	0.138	0.034
SE	0	0.324	0.324	0.324	0.027
NPDE	0	0	0.486	0.486	0.027
PDE	0	0	0	0.973	0.027
IFN 30 mg
NR	0.522	0.155	0.174	0.146	0.003
SE	0	0.324	0.324	0.324	0.029
NPDE	0	0	0.485	0.485	0.029
PDE	0	0	0	0.971	0.029
IFN + GA
NR	0.576	0.143	0.138	0.119	0.024
SE	0	0.325	0.325	0.325	0.025
NPDE	0	0	0.488	0.488	0.025
PDE	0	0	0	0.975	0.025

Source: Lublin et al.15

*Numbers in this figure have been rounded, which makes it possible that the total sum is not exactly 1.

Table 2. Drug costs for GA 20 mg, IFN 30 mg, and GA + IFN, per unit and year.

Type	GA	IFN	GA + IFN
Drug costs per year	9420 €^a	10,051 €^a	19,471 €^a
Total administration costs	–	912 €^b	912 €^b
Administration frequency	daily	weekly	daily and weekly
Total drug costs	9420 €	10,963 €	20,383 €

^aConsejo General de Colegios Oficiales de Farmaceuticos22.

^bSánchez-de la Rosa et al.24.

Note: Administration unit cost per week = 17.55 €.

Table 3. Annual resource utilization in units and unit costs in EUR 2013.

Type	Units	Cost in EUR 2013
Disease management costs^a
Follow-up visits neurologist	4	98.28€
Diagnostic tests:
Hematologies	4	11.93€
Biochemical determinations	4	15.59€
Control liver function	4	15.41€
Computed axial tomography	1	135.45€
Magnetic resonance imaging (MRI)	1	210.05€
Lumbar puncture	1	216.17€
Study of cerebrospinal fluid	1	37.95€
Suspect exacerbation^b
Physician visits	1	165.64€
Non-protocol defined exacerbation^b
Emergency visit	1	468.61€
Observation unit	1	2.082.58€
Initial office visit for acute problem	1	236.77€
Homecare	1	781.34€
Visits to a rehabilitation centre	1	204.21€
Protocol defined exacerbation^b
Medical visit due to relapse	1	468.61€
Hospital costs for total stay	1	8.663.77€
Visits to rehabilitation centre	1	14.741.82€
Outpatient care	1	112.47€
Homecare	1	2.015.50€

^aSánchez-de la Rosa et al.24.

^bO’Brien et al.25.

EUR, Euros.

Table 4. Total annual cost in EUR 2013 per health state.

	Cost in EUR 2013
Health state	GA	IFN	GA + IFN
No relapses	10,584.80€	12,127.60€	21,547.94€
Suspect exacerbations	10,750.43€	12,293.23€	21,713.57€
Non-protocol defined exacerbations	14,358.30€	15,901.10€	25,321.44€
Protocol defined exacerbations	36,586.95€	38,129.76€	47,550.10€

EUR, Euros.

Table 5. Total cost, incremental costs, relapse, relapse avoided and ICER.

Treatment	Cost in EUR 2013	Number of relapses	Incremental costs in EUR	Relapses avoided	ICER
1. GA	13,834 €	3.81	–
2. IFN	15,589 €	4.18	1756 € (1. vs 2.)	−0.37	Dominant (1. vs 2.)
3. IFN + GA	21,539 €	4.08	7705 € (1. vs 2.)	−0.27	Dominant (1. vs 2.)

EUR, Euros; ICER, Incremental Cost-Effectiveness Ratio.

Figure 2. Cost-effectiveness acceptability curves.

Lublin FD, Stacey S, Cofield SS, et al; Wolinsky JS, for the CombiRx Investigators; Randomized study combining interferon and glatiramer acetate in multiple sclerosis. Ann Neurol 2013;73:1-14

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