Exploring the Cost Effectiveness of Shared Decision Making for Choosing between Disease-Modifying Drugs for Relapsing-Remitting Multiple Sclerosis in the Netherlands: A State Transition Model

Ingrid E. H. Kremer*, Mickael Hiligsmann, Josh Carlson, Marita Zimmermann, Peter J. Jongen, Silvia M. A. A. Evers, Svenja Petersohn, Xavier G. L. V. Pouwels, Nick Bansback

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Web of Science)

Abstract

Background

Up 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.

Methods

An 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.

Results

Each 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.

Conclusion

This 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.

Original languageEnglish
Pages (from-to)1003-1019
Number of pages17
JournalMedical Decision Making
Volume40
Issue number8
DOIs
Publication statusPublished - Nov 2020

Keywords

  • disease-modifying drugs
  • early economic evaluation
  • multiple sclerosis
  • shared decision making
  • state transition model
  • RELEASE DIMETHYL FUMARATE
  • UNMET NEEDS TRIBUNE
  • GLATIRAMER ACETATE
  • INTERFERON BETA-1A
  • CONTROLLED PHASE-3
  • MEDICATION ADHERENCE
  • TREATMENT EXPERIENCE
  • PATIENT PREFERENCES
  • DOUBLE-BLIND
  • THERAPIES

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