Details

Autor(en) / Beteiligte

• Cartier-Bechu, C
• Sivignon, M
• Petitjean, A
• Roze, S
• Pinguet, J
• Tehard, B

Titel

How To Address French Health Authority (HAS/CEESP) Specific Requirements In Modelling Relapsing-Remitting Multiple Sclerosis In Health-Economic Evaluation? Modelling Treatment Sequences

Ist Teil von

• Value in health, 2017-10, Vol.20 (9), p.A752

Ort / Verlag

Lawrenceville: Elsevier Science Ltd

Erscheinungsjahr

2017

Quelle

Applied Social Sciences Index & Abstracts (ASSIA)

Beschreibungen/Notizen

• OBJECTIVES: The objective of the study was to track and assess the impact of introducing treatment sequences in a cost-effectiveness model for Relapsing-Remitting Multiple Sclerosis (RRMS) in France considering real life treatment patterns. Two health economic assessments in multiple sclerosis were published by the HAS/ CEESP since 2014. In both assessments two important methodological limitations were raised, focusing on the absence of treatment sequences as it didn't reflect real care management of RRMS patients. The resulting uncertainty of such limitations led the authorities to reduce the Time Horizon of the analysis to 5-10 years rather than a lifetime horizon (30 years) as recommended. METHODS: Two models were developed in treatment naive RRMS patients according to treatment sequences. For each model, two arms were considered as patients could receive a 1st disease modifying treatment (DMT) with ocrelizumab or interferon-beta-1a. The model with treatment sequences (M1) allows taking into account two treatment switches. After discontinuation of the 1st DMT, patients receive a 2nd DMT and then a 3rd DMT vs being off-treatment directly in former cost-effectiveness model (M2). Discontinuation of the 3rd DMT, achieving an EDSS score ≥7 or evolving towards SPMS state resulted in being off-treatment. RESULTS: Including treatment sequences allowed reducing the number of off-treatment patient-cycles in M1 versus M2. At 10 years, the number of patient off-treatment is: for ocrelizumab 5.5% in revised model versus 19.2% in classical model and for interferon-beta-1a 4.1% versus 23.8% respectively, either decrease patients off-treatment by 71% and 83%. At 30 years, patients off-treatment reduce by 27% and 17%. CONCLUSIONS: The CEESP pays particular attention to the uncertainty around cost-effectiveness assessment in regards of real life practice. The introduction of treatment sequences reduces dramatically the uncertainty associated with former models and brings a robust opportunity to increase the time horizon for future health economic assessment in MS.