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Cost utility of drugs for multiple sclerosis

BMJ 2000; 320 doi: (Published 27 May 2000) Cite this as: BMJ 2000;320:1474

Systematic review places study in context

  1. Jackie Bryant, research fellow,
  2. Andrew Clegg, senior research fellow,
  3. Ruairidh Milne, senior lecturer in public health medicine
  1. Wessex Institute for Health Research and Development, University of Southampton, Southampton SO16 7PX
  2. North Nottinghamshire Health Authority, Rainworth, Mansfield NG21 0ER
  3. Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT
  4. School of Health and Related Research, University of Sheffield, Sheffield S1 4DA
  5. North Staffordshire Royal Infirmary, Keele University, Stoke on Trent ST4 7LN
  6. Department of Neurology, Royal Victoria Hospital, Belfast BT12 6BA
  7. Ninewells Hospital and Medical School, Dundee DD1 9SY

    EDITOR—We were disappointed that Forbes et al's population based cost utility study of interferon beta-1b in secondary progressive multiple sclerosis was not placed in the context of a systematic review of relevant published work.1 We recently completed such a review of the effectiveness, costs, and utility of a range of disease modifying drugs in multiple sclerosis for the health technology assessment programme. As part of this, we searched various electronic databases for published studies of the cost utility of interferon beta in multiple sclerosis: Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effectiveness and NHS Economic Evaluations Database, Medline (Silverplatter), PubMed, Embase, and National Research Register (for the period 1980 to July 1999 and limited to English language studies). In addition, we contacted experts in the field.

    In addition to Forbes et al's study, we identified three further studies: one of beta interferons (1a and 1b) in both relapsing-remitting and secondary progressive sclerosis 2 and two further studies of interferon in relapsing-remitting multiple sclerosis.3 4

    The table shows a summary of the results of the review. The studies in secondary progressive multiple sclerosis are based on the same trial (n=718) but use different cost utility methodologies. Forbes et al's conclusion that the cost per quality adjusted life year (QALY) was very high (£1 024 667) owing to the high drug cost and modest clinical effect concurs with the previous study's estimate of £874 600 per QALY. The studies in relapsing-remitting multiple sclerosis also use the results of the existing randomised controlled trials in conjunction with various sources of cost data, quality of life measures, and different degrees of decision analytic modelling. Results show that the cost per QALY per relapse avoided is high in all studies.

    View this table:

    Cost per quality adjusted life …

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