When does economic model type become a decisive factor in health technology appraisals? Learning from the expanding treatment options for relapsing–remitting multiple sclerosis

ObjectiveGather health technology assessment (HTA) experts' insights on the desirability and acceptability of treatment-sequencing models applied to relapsing-remitting multiple sclerosis (RRMS).Data source/study settingPrimary data.Study designIn-depth double-blind semi-structured telephone interviews.Data collection/extraction methodsGeneral themes were extracted from qualitative interviews.Principal findingsAlthough experts confirmed the importance of evaluating the clinical and cost-effectiveness of treatments as part of a sequence, the current HTA decision making framework is not conducive to this. Developing an RRMS treatment-sequencing model that meets HTA requirements is difficult, in particular due to scarcity of effectiveness data in later treatment lines.ConclusionsAt present, a treatment-sequencing model for RRMS may be desirable yet not requested by HTA bodies for their decision making. However, there could be other areas where a treatment-sequencing model for RRMS is of use.

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PND20 HEALTH TECHNOLOGY ASSESSMENTS OF DISEASE-MODIFYING THERAPIES FOR THE TREATMENT OF RELAPSING- REMITTING MULTIPLE SCLEROSIS CHALLENGES IN NICE TECHNOLOGY APPRAISALS

Value in Health ◽

10.1016/j.jval.2019.09.1790 ◽

2019 ◽

Vol 22 ◽

pp. S739-S740

Author(s):

A. Lamb

Keyword(s):

Multiple Sclerosis ◽

Health Technology ◽

Disease Modifying Therapies ◽

Relapsing Remitting ◽

Disease Modifying ◽

Remitting Multiple Sclerosis ◽

Relapsing Remitting Multiple Sclerosis

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OP130 Economic Evaluation Of High-Cost Drugs For Relapsing-Remitting Multiple Sclerosis In Thailand

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462321000702 ◽

2021 ◽

Vol 37 (S1) ◽

pp. 2-3

Author(s):

Sarayuth Khuntha ◽

Nuttakarn Budtarad ◽

Pritaporn Kingkaew ◽

Phorntida Hadnorntun ◽

Pattara Leelahavarong

Keyword(s):

Multiple Sclerosis ◽

Economic Evaluation ◽

Usual Care ◽

Treatment Options ◽

Cost Effective ◽

National Database ◽

Relapsing Remitting ◽

Lifetime Costs ◽

Remitting Multiple Sclerosis ◽

Relapsing Remitting Multiple Sclerosis

IntroductionDrugs for relapsing-remitting multiple sclerosis (RRMS) are costly and not included in the National List of Essential Medicines of Thailand yet. This study aims to conduct an economic evaluation of high-cost drugs for RRMS.MethodsThe Markov model was used to estimate lifetime costs and quality-adjusted life years (QALYs) gained. The treatment options include Interferon beta-1a (IFN) and Teriflunomide (TERI) (first-line), Fingolimod (FIN) and Natalizumab (NATA) (second-line), and Alemtuzumab (ALEM) (third-line) compared with usual care. The effectiveness of drugs was retrieved by network meta-analysis. The probability of health state transition was obtained from primary data. Treatment-related costs were derived from the national database. Other costs and utilities were obtained from the study in Thai RRMS patients.ResultsThe lowest lifetime costs option was usual care (THB2 million) (USD65,808), while the highest QALY gained option was IFN-NATA-ALEM (8.6 QALY gained). All treatment options were not cost-effective compared with usual care at the threshold of THB160,000 (USD5,300) per QALY gained. However, the option of IFN-NATA-ALEM yielded the lowest incremental cost-effectiveness ratio (ICER), which was THB4.4 million (USD144,778) per QALY gained.ConclusionsHigh-cost drugs were not cost-effective; nonetheless, the IFN-NATA-ALEM option could increase QALY gained with the lowest additional budget. The government should negotiate the price of IFN to decrease by eighty percent.

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