BMJ 1999;319:1529-1533 ( 11 December )

Papers

Population based cost utility study of interferon beta-1b in secondary progressive multiple sclerosis

Raeburn B Forbes, research fellow, ^a Ann Lees, health economist, ^b Norman Waugh, director, ^c Robert J Swingler, consultant neurologist. ^a

^a Department of Neurology, Ninewells Hospital and Medical School, Dundee DD1 9SY, ^b Argyll and Clyde Health Board, Paisley PA2 7BN, ^c Scottish Health Purchasing Information Centre, Aberdeen AB15 6RE

Correspondence to: R B Forbes, Department of Neurology, Royal Victoria Hospital, Belfast BT12 6BA raeburn.forbes{at}royalhospitals.n-i-nhs.uk

Objective: To evaluate the cost utility of interferon beta-1b in secondary progressive multiple sclerosis.
Design: Population based cost utility model (healthcare perspective). Data on use of health services were obtained from case records and routine morbidity data and utility values from a EuroQol survey. Local and published costs were used. Effectiveness was modelled using data on relative risk reductions from a randomised trial of interferon beta-1b.
Setting: Tayside region, 1993-5.
Subjects: 132 ambulatory people with secondary progressive multiple sclerosis.
Main outcome measures: Cost per quality adjusted life year (QALY) gained. Rate of relapse and proportion becoming wheelchair dependent over three years.
Results: The number needed to treat for 30 months to delay time to wheelchair dependence in one person by nine months was 18 (95% confidence interval 5 to 26). For every 18 people treated for 30 months, six relapses would be prevented, gaining 0.397 discounted QALYs. The cost per QALY gained was £1 024 667 (£276 466 to £1 485 499). If treatment was restricted to patients attending neurology services, the number needed to treat was 14 (cost per QALY gained £833 514 (£161 358 to )). The cost per QALY gained was not sensitive to changes in cost which took account of a societal perspective.
Conclusions: The cost per QALY gained from interferon beta is high because of the high drug cost and modest clinical effect. Resources could be used more efficiently elsewhere.
.

Key messages Secondary progressive multiple sclerosis is a potentially disabling disorder associated with low health related quality of life Interferon beta-1b may reduce rate of relapse The benefits of interferon beta-1b treatment are very low relative to its cost Cost utility analysis estimated a cost of over £1m per QALY gained Cost per QALY was not affected by taking into account the costs of care Money would be better spent on other ways of improving quality of life than on interferon beta

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Rapid Responses:

Read all Rapid Responses

Cost Utility Analysis an analysis too far.

Simon J Ellis
bmj.com, 24 Dec 1999 [Full text]

Metholodical issues in calculating cost effectiveness

Richard Richards
bmj.com, 16 Jan 2000 [Full text]

Cost-utility of drugs for multiple sclerosis

Jackie Bryant
bmj.com, 18 Jan 2000 [Full text]

QALY approach is inappropraiate in disabled populations

E Fertl
bmj.com, 4 Feb 2000 [Full text]

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