EE321 A Re-Examination of a Cost-Minimization Analysis in Multiple Sclerosis: Assessing Biases from the Inaccurate Assumption of Equal Effectiveness Using Probabilistic Sensitivity Analysis (PSA)

Based on “similar” effectiveness, the economics of treating relapsing-remitting multiple sclerosis with fingolimod and natalizumab were studied a cost-minimization analysis (CMA) in 2012 based Swedish data. Fingolimod was cost-saving compared natalizumab. However, studies have shown difference efficacy favoring natalizumab, leading to possibility that, while more costly, it may be cost-effective. This study uses PSA estimate cost-effectiveness associated decision uncertainty for CMA CEA. A later publication, Vollmer (2018) indicated differences “disease activity.” We used those count data PSA. For cost difference, we original 2 year mean set standard error equal (85,128 SEK). then calculated incremental net monetary benefit each iteration uncertainty. did same, but setting effectiveness zero, reflecting CMA. previously published suggested WTP 500,000 SEK (approximately $US 55000) relapse avoidance. results similar deterministic analysis, suggesting is effective at values up 660,000 SEK. At SEK, probability that cost-effective 0.59, indicating significant In CMA-based PSA, this 0.84. The claimed as cost-saving. Our agreement, minimal Allowing greater still shows fingolimod’s CEA conclusion consistent CMA, there higher (and significant) uncertainty, potential value additional collection. has been increasingly faulted its assumptions our supports notion misleading.