Cost-utility analysis of interferon beta-1a (Avonex and Cinnovex) for relapsing remitting multiple sclerosis
,
Abstract
Background: Cinnovex is a biosimilar form of intramuscular (IM) interferon beta-1a (IFNβ-1a) manufactured in Iran for management of multiple sclerosis (MS). The present study aimed to determine the cost-utility of Cinnovex versus Avonex for patients with relapsing-remitting MS (RRMS) from Iranian health ministry perspective.Methods: A Markov model was developed to determine 10-year cost and quality-adjusted life-years (QALYs) of patients with transition through health states based on Kurtzke Expanded Disability Status Scale (EDSS). To estimate the cost of each method, we inquired the subsidies allocated to Avonex and Cinnovex by Iran’s health ministry. Moreover, to estimate the quality of life (QOL) of patients in each group, a cross-sectional study was conducted among two groups of patients who had used Avonex and Cinnovex (n = 50 and n = 50, respectively), using the multiple sclerosis quality of life-54 (MSQOL-54) questionnaire. Finally, one-way sensitivity analysis (tornado diagram) was performed in order to examine the strength of the results.Results: According to results, the estimated 10-year discounted cost per patient for Avonex and Cinnovex were 21346.5 international dollar ($Int) and 47436.6 $Int, respectively; while the estimated total discounted QALYs per person were 3.76 and 3.89, respectively. The incremental cost per QALY for Cinnovex compared with Avonex was 162718.55 $Int.Conclusion: It is concluded that Cinnovex in patients with progressive relapsing MS is cost-effective associated with increased benefits compared with Avonex.(1) Bell C, Graham J, Earnshaw S, Oleen-Burkey M, Castelli-Haley J, Johnson K. Cost-effectiveness of four immunomodulatory therapies for relapsing-remitting multiple sclerosis: A Markov model based on long-term clinical data. J Manag Care Pharm 2007; 13(3): 245-61.
(2) Frohman EM, Racke MK, Raine CS. Multiple sclerosis-the plaque and its pathogenesis. N Engl J Med 2006; 354(9): 942-55.
(3) Melcon MO, Correale J, Melcon CM. Is it time for a new global classification of multiple sclerosis? J Neurol Sci 2014; 344(1-2): 171-81.
(4) Dua T. Atlas: Multiple sclerosis resources in the world, 2008. Geneva, Switzerland: World Health Organization; 2008.
(5) Heydarpour P, Khoshkish S, Abtahi S, Moradi-Lakeh M, Sahraian MA. Multiple sclerosis epidemiology in middle east and north africa: A systematic review and meta-analysis. Neuroepidemiology 2015; 44(4): 232-44.
(6) Etemadifar M, Izadi S, Nikseresht A, Sharifian M, Sahraian MA, Nasr Z. Estimated prevalence and incidence of multiple sclerosis in Iran. Eur Neurol 2014; 72(5-6): 370-4.
(7) Izadi S, Nikseresht AR, Poursadeghfard M, Borhanihaghighi A, Heydari ST. Prevalence and incidence of multiple sclerosis in Fars province, southern Iran. Iran J Med Sci 2015; 40(5): 390-5.
(8) Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, et al. The natural history of multiple sclerosis: A geographically based study. 2. Predictive value of the early clinical course. Brain 1989; 112(Pt 6): 1419-28.
(9) Richards RG, Sampson FC, Beard SM, Tappenden P. A review of the natural history and epidemiology of multiple sclerosis: Implications for resource allocation and health economic models. Health Technol Assess 2002; 6(10): 1-73.
(10) Jongen PJ, Sindic C, Carton H, Zwanikken C, Lemmens W, Borm G, et al. Improvement of health-related quality of life in relapsing remitting multiple sclerosis patients after 2 years of treatment with intramuscular interferon-beta-1a. J Neurol 2010; 257(4): 584-9.
(11) Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. The IFNB Multiple Sclerosis Study Group. Neurology 1993; 43(4): 655-61.
(12) Etemadifar M, Maghzi AH, Hosseinzadeh A. Comparing side effects of cinnovex with avonex in relapsing remitting multiple sclerosis patients. J Isfahan Med Sch 2009; 27(93): 92-9. [In Persian].
(13) Fars News Agency. Epidemiology of multiple sclerosis in Iran [Online]. [cited 2010]; Available from: URL:
http://www.farsnews.com/newstext.php?nn=8906240574 [In Persian].
(14) Kurtzke JF. Rating neurologic impairment in multiple
sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33(11): 1444-52.
(15) Nafissi S, Azimi A, Amini-Harandi A, Salami S, Shahkarami MA, Heshmat R. Comparing efficacy and side effects of a weekly intramuscular biogeneric/biosimilar interferon beta-1a with Avonex in relapsing remitting multiple sclerosis: A double blind randomized clinical trial. Clin Neurol Neurosurg 2012; 114(7): 986-9.
(16) Sharafaddinzadeh N, Majdinasab N, Ghiasian M, Moravej-Aleali A. Efficacy of interferon ß1a (Cinnovex) in relapsing-remitting multiple sclerosis patients. Zahedan J Res Med Sci 2011; 13(2): 3-6. [In Persian].
(17) Arababadi MK, Mosavi R, Khorramdelazad H, Yaghini N, Zarandi ER, Araste M, et al. Cytokine patterns after therapy with Avonex®, Rebif®, Betaferon® and CinnoVex™ in relapsing-remitting multiple sclerosis in Iranian patients. Biomark Med 2010; 4(5): 755-9.
(18) Knobler RL, Greenstein JI, Johnson KP, Lublin FD, Panitch HS, Conway K, et al. Systemic recombinant human interferon-beta treatment of relapsing-remitting multiple sclerosis: Pilot study analysis and six-year follow-up. J Interferon Res 1993; 13(5): 333-40.
(19) Prosser LA, Kuntz KM, Bar-Or A, Weinstein MC. Cost-effectiveness of interferon beta-1a, interferon beta-1b, and glatiramer acetate in newly diagnosed non-primary progressive multiple sclerosis. Value Health 2004; 7(5): 554-68.
(20) Vickrey BG, Hays RD, Harooni R, Myers LW, Ellison GW. A health-related quality of life measure for multiple sclerosis. Qual Life Res 1995; 4(3): 187-206.
(21) Ghaem H, Borhani Haghighi A, Jafari P, Nikseresht AR. Validity and reliability of the Persian version of the multiple sclerosis quality of life questionnaire. Neurol India 2007; 55(4): 369-75.
(22) Jankovic SM, Kostic M, Radosavljevic M, Tesic D, Stefanovic-Stoimenov N, Stevanovic I, et al. Cost-effectiveness of four immunomodulatory therapies for relapsing-remitting multiple sclerosis: A Markov model based on data a Balkan country in socioeconomic transition. Vojnosanit Pregl 2009; 66(7): 556-62.
| Files | ||
| Issue | Vol 2 No 3/4 (2016) | |
| Section | Original Article(s) | |
| Keywords | ||
| Multiple sclerosis Interferon beta-1a Economic evaluation Cost-utility analysis | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
