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Viswanathan S, Vijayasingham L, Laurson-Doube J, Quek AML, Tan K, Yeo T, Seinn MMA, Ohnmar O, Estiasari R, Yassin N, Hiew FL, Pasco PM, Hoang NTT, Keosodsay S, Siritho S, Apiwattanakul M, Ros S, Dias de Deus BS, Remli R, Abdullah S, Lim SY. Multi-actor system dynamics in access to disease-modifying treatments for multiple sclerosis in Southeast Asia: A regional survey and suggestions for improvement. Mult Scler Relat Disord 2024; 85:105555. [PMID: 38547547 DOI: 10.1016/j.msard.2024.105555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Despite the global availability of multiple sclerosis (MS) treatments, accessing and financing them in Southeast Asia (SEA) remains a challenge. This descriptive survey-based study aimed to describe the current state of MS treatment access and local access dynamics within this region. METHODS The survey questionnaire, comprising of 15 closed-ended and five open-ended questions, was developed by three neurologists with expertise in MS and routine MS patient management, or had training in neuroimmunology. Questionnaire development was guided by the recent Atlas of MS and in alignment with the Access to Treatment framework, focusing on MS diagnosis and treatment issues in SEA. Fifteen neurologists experienced in managing MS across the region were identified as key informants for this study. RESULTS All fifteen neurologists participated in the survey via email and videoconferencing between January 2020 and February 2023, which included the following countries: Brunei, Cambodia, Indonesia, Malaysia, Myanmar, Lao PDR, Philippines, Singapore, Thailand, Timor-Leste, and Vietnam. All had at least five years of experience in managing MS patients and six had previously completed a neuroimmunology fellowship programme. SEA countries showed disparities in healthcare financing, availability of neurologists, MS treatments, and investigative tools. Access to MS disease-modifying treatments (DMTs) is hindered by high cost, lack of MS specialists, and weak advocacy efforts. On-label DMTs are not listed as essential medicines regionally except for interferon beta1a and teriflunomide in Malaysia. On-label monoclonals are available only in Malaysia, Singapore, and Thailand. Generic on-label DMTs are unavailable due to lack of distributorship and expertise in using them. Off-label DMTs (azathioprine, methotrexate, and rituximab) predominate in most SEA countries. Other challenges include limited access to investigations, education, and knowledge about DMTs among general neurologists, and absence of registries and MS societies. Patient champions, communities, and MS organisations have limited influence on local governments and pharmaceutical companies. Despite its increasing prevalence, there is a lack of concerted priority setting due to MS being perceived as a rare, non-communicable disease. CONCLUSION This study highlights the distinct dynamics, challenges, and research gaps within this region, and provides suggestions to improve MS diagnosis, education, and medicine access.
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Affiliation(s)
| | - Lavanya Vijayasingham
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Amy M L Quek
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Tianrong Yeo
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Ohnmar Ohnmar
- Department of Neurology, Yangon General Hospital, Yangon, Myanmar
| | - Riwanti Estiasari
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Neurology Department, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Norazieda Yassin
- Brunei Neuroscience Stroke and Rehabilitation Centre, Pantai Jerudong Specialist Centre, Brunei
| | | | - Paul M Pasco
- Department of Neurosciences, Philippine General Hospital, Manila, Philippines
| | - Nghia T T Hoang
- Department of Neurology, Military Hospital 175, Ho Chi Minh City, Vietnam
| | | | - Sasitorn Siritho
- Department of Neurology, Bumrungrad International Hospital and Siriraj Hospital, Mahidol, Bangkok, Thailand
| | | | - Sina Ros
- Department of Neurology, Calmette Hospital, Phnom Penh, Cambodia
| | | | - Rabani Remli
- Department of Neurology, National University of Malaysia, Malaysia
| | | | - Su-Yin Lim
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Malaysia.
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Gallehzan NA, Khosravi M, Jamebozorgi K, Mir N, Jalilian H, Soleimanpour S, Hoseini S, Rezapour A, Eshraghi A. Cost-utility and cost-effectiveness analysis of disease-modifying drugs of relapsing-remitting multiple sclerosis: a systematic review. HEALTH ECONOMICS REVIEW 2024; 14:12. [PMID: 38363408 PMCID: PMC10870486 DOI: 10.1186/s13561-024-00478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 01/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, autoimmune, and inflammatory disease. The economic burden of MS is substantial, and the high cost of Disease-modifying drugs (DMDs) prices are the main drivers of healthcare expenditures. We conducted a systematic review of studies evaluating the cost-utility and cost-effectiveness of DMDs for relapsing-remitting multiple sclerosis (RRMS). MATERIALS AND METHOD Searches were conducted in PubMed, Web of Science, Scopus, and Embase. The search covered articles published between May 2001 and May 2023. Studies that were written in English and Persian and examined the cost-utility and cost-effectiveness of DMDs in patients with MS were included in our review. Data extraction was guided by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, and the quality of economic evaluations was assessed using the Quality of Health Economics Studies Instrument (QHES). All costs were converted to 2020 U.S. dollars using Purchasing Power Parity (PPP). RESULTS The search yielded 1589 studies, and 49 studies were eligible for inclusion. The studies were mainly based on a European setting. Most studies employed Markov model to assess the cost-effectiveness. The lowest and highest numerical value of outcome measures were -1,623,918 and 2,297,141.53, respectively. Furthermore, the lowest and highest numerical value of the cost of DMDs of RRMS were $180.67, and $1474840.19, respectively. CONCLUSIONS Based on the results of all studies, it can be concluded that for the treatment of patients with MS, care-oriented strategies should be preferred to drug strategies. Also, among the drug strategies with different prescribing methods, oral disease-modifying drugs of RRMS should be preferred to injectable drugs and intravenous infusions.
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Affiliation(s)
- Nasrin Abulhasanbeigi Gallehzan
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Khosravi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Nazanin Mir
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Habib Jalilian
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Samira Soleimanpour
- Department of Medical Library and Information Science, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Hoseini
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Eshraghi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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Guojun T, Yan X, Weizhi W, Lihua W, Chunyang L, Xinghu Z, Hongyu Z, Huiqing D, Meini Z, Tao J, Huan Y, Liying C, Li G. A multicenter study to evaluate the disease burden and health economics of inpatients with multiple sclerosis in China. Mult Scler Relat Disord 2022; 60:103732. [PMID: 35325723 DOI: 10.1016/j.msard.2022.103732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the disease burden and health economics of inpatients with multiple sclerosis (MS) in China by evaluating the direct, indirect, and intangible costs. METHODS A total of 863 patients were included for a cross-sectional retrospective study in 50 centers. The direct economic burden was measured by the cost of hospitalization and out-of-hospital application drugs, and the indirect economic burden was measured by the human capital method. The disability-adjusted life year (DALY) was used to express the intangible economic burden. Cost-utility analysis (CUA) using DALYs as indicators of health benefits was performed by calculating the incremental cost-utility ratio. RESULTS The mean direct economic burden/year, daily medication expenses/year, DALY, indirect economic burden, and indirect economic burden/year were 27,655.57 Yuan, 17,944.97 Yuan, 10.89 Yuan, 512,041.7 Yuan, and 11,299.85 Yuan, respectively. For the study period of two years, the direct economic burden, daily medication expense, and indirect economic burden were 48.6%, 31.5%, and 19.85% of the total economic burden, respectively. Disease burden and the number of episodes of remission were not statistically significant (p>0.001). The direct economic burden and total economic burden of the disease-modifying therapy (DMT) group were higher than those of the non-DMT group, but DALYs had no statistical significance (p>0.001). CUA showed that inpatients with MS in the DMT group received a DALY every time compared with the non-DMT group. CONCLUSION The DALY losses are concentrated in young and middle-aged Chinese people. In this two-year study, CUA prompted the application of DMT drugs to increase the economic burden and DALYs. However, follow-up time is still short, and further follow-up observation is required.
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Affiliation(s)
- Tan Guojun
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China; Neurological Laboratory of Hebei Province, Shijiazhuang, 050000, Hebei, China
| | - Xu Yan
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wang Weizhi
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Wang Lihua
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Li Chunyang
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Zhang Xinghu
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhou Hongyu
- West China Hospital, Sichuan University, Chengdu, China
| | - Dong Huiqing
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhang Meini
- The First Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Jin Tao
- The First Hospital of Jilin University, Changchun, China
| | - Yang Huan
- Xiangya Hospital, Central South University, Changsha, China
| | - Cui Liying
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Guo Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.
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Wiyani A, Badgujar L, Khurana V, Adlard N. How have Economic Evaluations in Relapsing Multiple Sclerosis Evolved Over Time? A Systematic Literature Review. Neurol Ther 2021; 10:557-583. [PMID: 34279847 PMCID: PMC8571458 DOI: 10.1007/s40120-021-00264-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The introduction of disease-modifying therapies (DMTs) for relapsing multiple sclerosis (RMS) over the last two decades has prompted the economic assessments of these treatments by reimbursement authorities. The aim of this systematic literature review was to evaluate the modeling approach and data sources used in economic evaluations of DMTs for RMS, identify differences and similarities, and explore how economic evaluation models have evolved over time. METHODS MEDLINE®, Embase®, and EBM Reviews databases were searched using Ovid® Platform from database inception on 25 December 2019 and subsequently updated on 17 February 2021. In addition, health technology assessment agency websites, key conference proceedings, and gray literature from relevant websites were screened. The quality of included studies was assessed using the Drummond and Philips checklists. RESULTS A total 155 publications and 30 Health Technology Assessment (HTA) reports were included. Most of these were cost-utility analysis (73 studies and 25 HTA reports) and funded by medicines manufacturers (n = 65). The top three countries where studies were conducted were the USA (n = 29), the UK (n = 16), and Spain (n = 10). Studies predominantly used Markov cohort models (94 studies; 25 HTAs) structured based on the Expanded Disability Status Scale (EDSS) with 21 health states (20 studies; 12 HTA reports). The London Ontario and British Columbia data sets were commonly used sources for natural history data (n = 33; n = 13). Twelve studies and ten HTAs from the UK assumed a waning of DMT effect over the long term, while this was uncommon in studies from other countries. Nineteen studies adjusted for multiple sclerosis (MS)-specific mortality estimates, while 18 studies used data from the national life table without adjustment. Studies prominently referred to mortality data that were about two decades old. The data on treatment effect was generally obtained from randomized controlled trials (43 studies; 7 HTAs) or from published evidence synthesis (23 studies; 24 HTAs). Utility estimates were derived from either published studies and/or supplemented with data from RCTs. Most of the models used the lifetime horizon (n = 37) with a 1-year cycle length (n = 63). CONCLUSION As expected, similarities as well as differences were observed across the different economic models. Available evidence suggests models should continue using the Markov cohort model with 21 EDSS-based states, however, allowing the transition to a lower EDSS state and assuming a sustained treatment effect. With reference to the data sources, models should consider using a contemporary MS-specific mortality data, recent natural history data, and country-specific utility data if available. In case of data unavailability, a sensitivity analysis using multiple sources of data should be conducted. In addition, future models should incorporate other clinically relevant outcomes, such as the cognition, vision, and psychological aspects of RMS, to be able to present the comprehensive value of DMTs.
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Affiliation(s)
- Anggie Wiyani
- Novartis Corporation (Malaysia) Sdn. Bhd., Petaling Jaya, Malaysia.
| | | | - Vivek Khurana
- Novartis Corporation (Malaysia) Sdn. Bhd., Petaling Jaya, Malaysia
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Ngorsuraches S, Poudel N. Incorporating patients' preferences in the value assessment of disease-modifying therapies for multiple sclerosis: a narrative review. Expert Rev Pharmacoecon Outcomes Res 2021; 21:183-195. [PMID: 33472451 DOI: 10.1080/14737167.2021.1880321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Despite the increasing role of patients in the US healthcare system, patients have yet been engaged in the value assessment of their treatments, including disease-modifying therapies (DMTs) for multiple sclerosis (MS). The objectives of this review were therefore to summarize existing studies on cost-effectiveness analysis (CEA) with quality-adjusted life years (QALYs) and patients' preferences of DMTs for MS, and to discuss how to incorporate patients' preferences into the value assessment of DMTs.Area covered: We reviewed previous systematic reviews and conducted further search until November 2020 for studies on CEA with QALYs and patients' preferences of DMTs for MS. We identified the outcomes that were assessed or valued in the CEA studies and the DMT attributes that were important to patients with MS.Expert opinion: Our literature review showed that the studies using CEA with QALYs failed to capture some important DMT attributes, e.g., route and frequency of administration, identified in the studies on the patients' preferences. Various approaches were available for incorporating the patients' preferences in the value assessment of DMTs for MS. We supported this incorporation, which subsequently would increase patient access to preferred DMTs.
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Affiliation(s)
- Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Auburn University, Harrison School of Pharmacy, Auburn, AL, USA
| | - Nabin Poudel
- Department of Health Outcomes Research and Policy, Auburn University, Harrison School of Pharmacy, Auburn, AL, USA
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Aungsumart S, Apiwattanakul M. Cost effectiveness of rituximab and mycophenolate mofetil for neuromyelitis optica spectrum disorder in Thailand: Economic evaluation and budget impact analysis. PLoS One 2020; 15:e0229028. [PMID: 32050011 PMCID: PMC7015451 DOI: 10.1371/journal.pone.0229028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/28/2020] [Indexed: 01/01/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory condition of the central nervous system. The extent of disability depends on the severity of the disease and the number of relapses. Although azathioprine is currently the main treatment for patients with NMOSD in Thailand, patients often relapse during its use. Hence, it is argued that there are other drugs that would be more effective. The purpose of this study is to evaluate, from a societal perspective and from the economic impact on Thailand’s healthcare system, the cost utility of treatment with mycophenolate mofetil (MMF) and rituximab in patients resistant to azathioprine. The Markov model with a one-year cycle length was applied to predict the health and cost outcomes in patients with NMOSD over a lifetime. The results showed that rituximab exhibited the highest quality-adjusted life year (QALY) gains among all the options. Among the rituximab-based treatments, the administration of a rituximab biosimilar with CD27+ memory B cell monitoring proved to be the most cost-effective option. At the willingness-to-pay threshold of 160,000 Thai baht (THB), or 5,289 US dollar (USD), per QALY gained, the treatment exhibited the highest probability of being cost effective (48%). A sensitivity analysis based on the adjusted price of a generic MMF determined that the treatment was cost effective, exhibiting an incremental cost-effectiveness ratio of -164,653 THB (-5,443 USD) and a 32% probability of being cost effective. The calculated budget impact of treating patients resistant to conventional therapy was 1–6 million THB (33,000–198,000 USD) for the first three years, while after the third year, the budget impact stabilized at 3–4 million THB (99,000–132,000 USD). These data indicate that, in Thailand, treatment of drug resistant NMOSD with a rituximab biosimilar with CD27+ memory B cell monitoring or treatment with a generic MMF would be cost effective and would result in a low budget impact. Therefore, the inclusion of both the rituximab biosimilar and a generic MMF in the National Drug List of Essential Medicine for the treatment of NMOSD may be appropriate.
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Affiliation(s)
- Saharat Aungsumart
- Neuroimmunology Unit, Department of Neurology, Prasat Neurological Institute, Bangkok, Thailand
- * E-mail:
| | - Metha Apiwattanakul
- Neuroimmunology Unit, Department of Neurology, Prasat Neurological Institute, Bangkok, Thailand
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