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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

Author

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  • Ingrid E. H. Kremer

    (Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
    School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada)

  • Mickael Hiligsmann

    (Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands)

  • Josh Carlson

    (Department of Pharmacy, University of Washington, Seattle, WA, USA)

  • Marita Zimmermann

    (Institute for Disease Modeling, Bellevue, WA, USA)

  • Peter J. Jongen

    (MS4 Research Institute, Nijmegen, The Netherlands
    Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, The Netherlands)

  • Silvia M. A. A. Evers

    (Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
    Centre for Economic Evaluations, Trimbos Institute, Utrecht, The Netherlands)

  • Svenja Petersohn

    (Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
    Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands)

  • Xavier G. L. V. Pouwels

    (Department of Health Technology & Services Research, Faculty of Behavioral, Management & Social Sciences, University of Twente, Enschede, The Netherlands)

  • Nick Bansback

    (School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada)

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 €17,875 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.

Suggested Citation

  • 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, 2020. "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," Medical Decision Making, , vol. 40(8), pages 1003-1019, November.
    • Handle: RePEc:sae:medema:v:40:y:2020:i:8:p:1003-1019
    DOI: 10.1177/0272989X20961091
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    References listed on IDEAS

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    1. Gisela Kobelt & J. Berg & P. Lindgren, 2006. "Costs and quality of life in multiple sclerosis in The Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 7(2), pages 55-64, July.
    2. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
    3. Julia Krämer & Jan-Gerd Tenberge & Ingo Kleiter & Wolfgang Gaissmaier & Tobias Ruck & Christoph Heesen & Sven G Meuth, 2017. "Is the risk of progressive multifocal leukoencephalopathy the real reason for natalizumab discontinuation in patients with multiple sclerosis?," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-17, April.
    4. Gisela Kobelt & J. Berg & P. Lindgren, 2006. "Costs and quality of life in multiple sclerosis in The Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 7(02), pages 55-64, July.
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