TY - JOUR
T1 - Exploring the Cost Effectiveness of Shared Decision Making for Choosing between Disease-Modifying Drugs for Relapsing-Remitting Multiple Sclerosis in the Netherlands
T2 - A State Transition Model
AU - Kremer, Ingrid E. H.
AU - Hiligsmann, Mickael
AU - Carlson, Josh
AU - Zimmermann, Marita
AU - Jongen, Peter J.
AU - Evers, Silvia M. A. A.
AU - Petersohn, Svenja
AU - Pouwels, Xavier G. L. V.
AU - Bansback, Nick
N1 - Funding Information:
This work was conducted in part as a visiting fellowship of Ingrid Kremer at the University of British Columbia. This fellowship was made possible by a Student Research Award of the Association for Canada Studies in the Netherlands.
Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Zimmermann has previously served as a consultant for Genentech. The consultancy did not involve any of the products included in the present manuscript, nor did the consultancy influence the results presented here. Dr. Carlson has received a grant from the Institute for Clinical and Economic Reviews to develop an economic model evaluating drugs to treat multiple sclerosis and a grant from the Benaroya Research Institute for work on the BEAT-MS clinical trial. Dr. Jongen received honoraria from Bayer BV, Mijdrecht, The Netherlands, for educational or consultancy activities, and from MS sherpa BV, Nijmegen, The Netherlands, for consultancy activities. Dr. Evers, Dr. Hiligsmann, Dr. Jongen, and Dr. Kremer have received a research grant from Bayer B.V. through the institution. The other authors declare no conflict of interest.
Publisher Copyright:
© The Author(s) 2020.
PY - 2020/11
Y1 - 2020/11
N2 - BackgroundUp to 31% of patients with relapsing-remitting multiple sclerosis (RRMS) discontinue treatment with disease-modifying drug (DMD) within the first year, and of the patients who do continue, about 40% are nonadherent. Shared decision making may decrease nonadherence and discontinuation rates, but evidence in the context of RRMS is limited. Shared decision making may, however, come at additional costs. This study aimed to explore the potential cost-effectiveness of shared decision making for RRMS in comparison with usual care, from a (limited) societal perspective over a lifetime.MethodsAn exploratory economic evaluation was conducted by adapting a previously developed state transition model that evaluates the cost-effectiveness of a range of DMDs for RRMS in comparison with the best supportive care. Three potential effects of shared decision making were explored: 1) a change in the initial DMD chosen, 2) a decrease in the patient's discontinuation in using the DMD, and 3) an increase in adherence to the DMD. One-way and probabilistic sensitivity analyses of a scenario that combined the 3 effects were conducted.ResultsEach effect separately and the 3 effects combined resulted in higher quality-adjusted life years (QALYs) and costs due to the increased utilization of DMD. A decrease in discontinuation of DMDs influenced the incremental cost-effectiveness ratio (ICER) most. The combined scenario resulted in an ICER of euro17,875 per QALY gained. The ICER was sensitive to changes in several parameters.ConclusionThis study suggests that shared decision making for DMDs could potentially be cost-effective, especially if shared decision making would help to decrease treatment discontinuation. Our results, however, may depend on the assumed effects on treatment choice, persistence, and adherence, which are actually largely unknown.
AB - BackgroundUp to 31% of patients with relapsing-remitting multiple sclerosis (RRMS) discontinue treatment with disease-modifying drug (DMD) within the first year, and of the patients who do continue, about 40% are nonadherent. Shared decision making may decrease nonadherence and discontinuation rates, but evidence in the context of RRMS is limited. Shared decision making may, however, come at additional costs. This study aimed to explore the potential cost-effectiveness of shared decision making for RRMS in comparison with usual care, from a (limited) societal perspective over a lifetime.MethodsAn exploratory economic evaluation was conducted by adapting a previously developed state transition model that evaluates the cost-effectiveness of a range of DMDs for RRMS in comparison with the best supportive care. Three potential effects of shared decision making were explored: 1) a change in the initial DMD chosen, 2) a decrease in the patient's discontinuation in using the DMD, and 3) an increase in adherence to the DMD. One-way and probabilistic sensitivity analyses of a scenario that combined the 3 effects were conducted.ResultsEach effect separately and the 3 effects combined resulted in higher quality-adjusted life years (QALYs) and costs due to the increased utilization of DMD. A decrease in discontinuation of DMDs influenced the incremental cost-effectiveness ratio (ICER) most. The combined scenario resulted in an ICER of euro17,875 per QALY gained. The ICER was sensitive to changes in several parameters.ConclusionThis study suggests that shared decision making for DMDs could potentially be cost-effective, especially if shared decision making would help to decrease treatment discontinuation. Our results, however, may depend on the assumed effects on treatment choice, persistence, and adherence, which are actually largely unknown.
KW - disease-modifying drugs
KW - early economic evaluation
KW - multiple sclerosis
KW - shared decision making
KW - state transition model
KW - RELEASE DIMETHYL FUMARATE
KW - UNMET NEEDS TRIBUNE
KW - GLATIRAMER ACETATE
KW - INTERFERON BETA-1A
KW - CONTROLLED PHASE-3
KW - MEDICATION ADHERENCE
KW - TREATMENT EXPERIENCE
KW - PATIENT PREFERENCES
KW - DOUBLE-BLIND
KW - THERAPIES
U2 - 10.1177/0272989X20961091
DO - 10.1177/0272989X20961091
M3 - Article
C2 - 33174513
SN - 0272-989X
VL - 40
SP - 1003
EP - 1019
JO - Medical Decision Making
JF - Medical Decision Making
IS - 8
ER -