Effectiveness, health outcomes and cost-effectiveness of first generation disease-modifying drugs in relapsing-onset multiple sclerosis: Nova Scotia evidence 1979-2010

2017 ◽  
Author(s):  
Murray G. Brown
Keyword(s):  
Multiple Sclerosis ◽  
Cost Effectiveness ◽  
Nova Scotia ◽  
Health Outcomes ◽  
First Generation ◽  
Disease Modifying Drugs ◽  
Disease Modifying

Disease-modifying drugs for multiple sclerosis and infection risk: a cohort study

2018 ◽  
Vol 89 (10) ◽  
pp. 1050-1056 ◽  
Author(s):  
José Maria Andreas Wijnands ◽  
Feng Zhu ◽  
Elaine Kingwell ◽  
John David Fisk ◽  
Charity Evans ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
First Generation ◽  
Second Generation ◽  
Population Based ◽  
Infection Risk ◽  
Disease Modifying Drugs ◽  
Drug Classes ◽  
Increased Risk ◽  
Disease Modifying ◽  
Status Index

ObjectiveLittle is known about disease-modifying treatments (DMTs) for multiple sclerosis (MS) and infection risk in clinical practice. We examined the association between DMTs and infection-related medical encounters.MethodsUsing population-based administrative data from British Columbia, Canada, we identified MS cases and followed them from their first demyelinating event (1996–2013) until emigration, death or study end (December 2013). Associations between DMT exposure (by DMT generation or class) and infection-related physician or hospital claims were assessed using recurrent time-to-events models, adjusted for age, sex, socioeconomic status, index year and comorbidity count. Results were reported as adjusted HRs (aHRs).ResultsOf 6793 MS cases, followed for 8.5 years (mean), 1716 (25.3%) were DMT exposed. Relative to no DMT, exposure to any first-generation DMT (beta-interferon or glatiramer acetate) was not associated with infection-related physician claims (aHR: 0.96; 95% CI 0.89 to 1.02), nor was exposure to these drug classes when assessed separately. Exposure to any second-generation DMT (oral DMT or natalizumab) was associated with an increased hazard of an infection-related physician claim (aHR: 1.47; 95% CI 1.16 to 1.85); when assessed individually, the association was significant for natalizumab (aHR: 1.59; 95% CI 1.19 to 2.11) but not the oral DMTs (aHR: 1.17; 95% CI 0.88 to 1.56). While no DMTs were associated with infection-related hospital claims, these hospitalisations were also uncommon.ConclusionExposure to first-generation DMTs was not associated with an altered infection risk. However, exposure to the second-generation DMTs was, with natalizumab associated with a 59% increased risk of an infection-related physician claim. Continued pharmacovigilance is warranted, including an investigation of the DMT-associated infection burden on patient outcomes.

scholarly journals Disease-modifying drugs for multiple sclerosis and subsequent health service use

2021 ◽  
pp. 135245852110634
Author(s):  
Huah Shin Ng ◽  
Feng Zhu ◽  
Elaine Kingwell ◽  
Yinshan Zhao ◽  
Shenzhen Yao ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
First Generation ◽  
Service Use ◽  
Second Generation ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Population Based ◽  
Disease Modifying Drugs ◽  
Physician Visits ◽  
Disease Modifying

Objective: We assessed the relationship between the multiple sclerosis (MS) disease-modifying drugs (DMDs) and healthcare use. Methods: Persons with MS (aged ⩾18 years) were identified using linked population-based health administrative data in four Canadian provinces and were followed from the most recent of their first MS/demyelinating event or 1 January 1996 until the earliest of death, emigration, or study end (31 December 2017 or 31 March 2018). Prescription records captured DMD exposure, examined as any DMD, then by generation (first-generation (the injectables) or second-generation (orals/infusions)) and individual DMD. The associations with subsequent all-cause hospitalizations and physician visits were examined using proportional means model and negative binomial regression. Results: Of 35,894 MS cases (72% female), mean follow-up was 12.0 years, with person-years of DMD exposure for any, or any first- or second-generation DMD being 63,290, 54,605 and 8685, respectively. Any DMD or any first-generation DMD exposure (versus non-exposure) was associated with a 24% lower hazard of hospitalization (adjusted hazard ratio, aHR: 0.76; 95% confidence intervals (CIs): 0.71–0.82), rising to 29% for the second-generation DMDs (aHR: 0.71; 95% CI: 0.58–0.88). This ranged from 18% for teriflunomide (aHR: 0.82; 95% CI: 0.67–1.00) to 44% for fingolimod (aHR: 0.56; 95% CI: 0.36–0.87). In contrast, DMD exposure was generally not associated with substantial differences in physician visits. Conclusion: Findings provide real-world evidence of a beneficial relationship between DMD exposure and hospitalizations.

scholarly journals A Comprehensive Cost-Effectiveness Analysis of Treatments for Multiple Sclerosis

2011 ◽  
Vol 13 (3) ◽  
pp. 128-135 ◽  
Author(s):  
Ashley N. Newton ◽  
Christina M. Stica
Keyword(s):  
Multiple Sclerosis ◽  
Cost Effectiveness ◽  
Interferon Beta ◽  
First Line ◽  
Disease Modifying Drugs ◽  
Future Studies ◽  
Relapsing Remitting ◽  
Disease Modifying ◽  
The Cost ◽  
Relapsing Remitting Multiple Sclerosis

The purpose of this study was to examine the cost-effectiveness of four disease-modifying drugs (DMDs) used to treat multiple sclerosis (MS): glatiramer acetate (GA; Copaxone), interferon beta-1a (IFNβ-1a) intramuscular (IM) injection (Avonex), IFNβ-1a subcutaneous (SC) injection (Rebif), and interferon beta-1b (IFNβ-1b) SC injection (Betaseron). Cost-effectiveness analyses are useful in countering the financial uncertainties and treatment efficacy concerns faced by people with MS. We conducted simulation analyses of the principal findings of a 2009 study by Goldberg et al. (Goldberg LD, Edwards NC, Fincher C, et al: Comparing the cost-effectiveness of disease-modifying drugs for the first-line treatment of relapsing remitting multiple sclerosis. J Manag Care Pharm. 2009;15:543–555) to frame the researchers' findings from the perspectives of cost-conscious and cost-neutral MS patients. We found that for the cost-conscious consumer, the ranking of most (1) to least (4) preferred DMDs was 1) IFNβ -1a IM (Avonex), 2) GA (Copaxone), 3) IFNβ-1a SC (Rebif), and 4) IFNβ-1b SC (Beta-seron). For the cost-neutral consumer who places priority on effectiveness over costs, the ranking was 1) IFNβ-1a SC (Rebif), 2) IFNβ-1b SC (Betaseron), 3) GA (Copaxone), and 4) IFNβ-1a IM (Avonex). Future studies could examine cost-effectiveness over extended periods of time (eg, 15–20 years) and more closely examine the cost-effectiveness of natalizumab (Tysabri) relative to the four primary DMDs.

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