PMID- 29923439
OWN - NLM
STAT- MEDLINE
DCOM- 20190114
LR  - 20190114
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 21
IP  - 10
DP  - 2018 Oct
TI  - When does economic model type become a decisive factor in health technology 
      appraisals? Learning from the expanding treatment options for relapsing-remitting 
      multiple sclerosis.
PG  - 983-992
LID - 10.1080/13696998.2018.1491007 [doi]
AB  - OBJECTIVES: Specific economic model types often become de facto standard for 
      health technology appraisal over time. Markov and discrete event simulation (DES) 
      models were compared to investigate the impact of innovative modeling on the 
      cost-effectiveness of disease-modifying therapies (DMTs) in relapsing-remitting 
      multiple sclerosis (RRMS). Fingolimod was compared to dimethyl fumarate (DMF; in 
      highly active [HA] RRMS), alemtuzumab (in HA RRMS) and natalizumab (in rapidly 
      evolving severe RRMS). Comparator DMTs were chosen to reflect different dosing 
      regimens. MATERIALS AND METHODS: Markov and DES models used have been published 
      previously. Inputs were aligned in all relevant respects, with differences in the 
      modeling of event-triggered attributes, such as relapse-related retreatment, 
      which is inherently difficult with a memoryless Markov approach. Outcomes were 
      compared, with and without different attributes. RESULTS: All results used list 
      prices. For fingolimod and DMF, incremental cost-effectiveness ratios (ICERs) 
      were comparable (Markov:  pound4206/quality-adjusted life year [QALY] gained versus 
      DES:  pound3910/QALY gained). Deviations were observed when long-term adverse events 
      (AEs) were incorporated in the DES (Markov:  pound25,412 saved/QALY lost, versus DES: 
       pound34,209 saved/QALY lost, fingolimod versus natalizumab; higher ICERs indicate 
      greater cost-effectiveness). For fingolimod versus alemtuzumab, when 
      relapse-triggered retreatment was included in the DES, large cost differences 
      were observed (difference between incremental cost is  pound35,410 and QALY is 0.10). 
      LIMITATIONS: UK payer perspective, therefore societal approach was not 
      considered. Resource utilization and utilities for both models were not derived 
      from the subpopulations; as the focus is on model type, input limitations that 
      apply to both models are less relevant. CONCLUSIONS: Whilst no model can fully 
      represent a disease, a DES allows an opportunity to include features excluded in 
      a Markov structure. A DES may be more suitable for modeling in RRMS for health 
      technology assessment purposes given the complexity of some DMTs. This analysis 
      highlights the capabilities of different model structures to model 
      event-triggered attributes.
FAU - Noon, Kathleen Mary
AU  - Noon KM
AD  - a Costello Medical Consulting Ltd , London , UK.
FAU - Montgomery, Stephen Maxwell
AU  - Montgomery SM
AUID- ORCID: 0000-0002-8481-5850
AD  - b Costello Medical Consulting Ltd , Cambridge , UK.
FAU - Adlard, Nicholas Edward
AU  - Adlard NE
AD  - c Novartis Pharma AG , Basel , Switzerland.
FAU - Kroes, Michel Anton
AU  - Kroes MA
AD  - d Novartis Pharmaceuticals UK Ltd , Surrey , UK.
LA  - eng
PT  - Journal Article
DEP - 20180705
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Natalizumab)
RN  - 3A189DH42V (Alemtuzumab)
RN  - FO2303MNI2 (Dimethyl Fumarate)
RN  - G926EC510T (Fingolimod Hydrochloride)
SB  - IM
MH  - Adult
MH  - Alemtuzumab/economics/therapeutic use
MH  - Cost-Benefit Analysis
MH  - Dimethyl Fumarate/economics/therapeutic use
MH  - Female
MH  - Fingolimod Hydrochloride/economics/therapeutic use
MH  - Health Resources/economics/statistics & numerical data
MH  - Health Services/economics/statistics & numerical data
MH  - Humans
MH  - Immunosuppressive Agents/*economics/*therapeutic use
MH  - Male
MH  - Markov Chains
MH  - *Models, Economic
MH  - Multiple Sclerosis, Relapsing-Remitting/*drug therapy
MH  - Natalizumab/economics/therapeutic use
MH  - Technology Assessment, Biomedical/*methods
OTO - NOTNLM
OT  - C52
OT  - Cost-effectiveness
OT  - I19
OT  - disease-modifying therapy
OT  - economic modeling
OT  - multiple sclerosis
EDAT- 2018/06/21 06:00
MHDA- 2019/01/15 06:00
CRDT- 2018/06/21 06:00
PHST- 2018/06/21 06:00 [pubmed]
PHST- 2019/01/15 06:00 [medline]
PHST- 2018/06/21 06:00 [entrez]
AID - 10.1080/13696998.2018.1491007 [doi]
PST - ppublish
SO  - J Med Econ. 2018 Oct;21(10):983-992. doi: 10.1080/13696998.2018.1491007. Epub 
      2018 Jul 5.