Friday, 27 January 2017

The Dre Approach to treating RR MS

Sawad AB, Seoane-Vazquez E, Rodriguez-Monguio R, Turkistani F. Cost-effectiveness of different strategies for treatment relapsing-remitting multiple sclerosis. J Comp Eff Res. 2017 . doi: 10.2217/cer-2016-0056. [Epub ahead of print]

AIM:To compare the cost-effectiveness of different disease-modifying therapies' strategies for treatment of relapsing-remitting multiple sclerosis.
METHODS:A Markov model was developed to assess the cost-effectiveness and incremental cost-effectiveness ratios for different strategies of using disease-modifying therapies from a US third-party payer perspective. All costs were converted to 2014 US$.
RESULTS: Over 20 years, the total costs per patient were estimated at US$161,136.60 for Strategy 1 (symptom management [SM] alone), US$551,650.66 for Strategy 2 (SM and IFN-β-1a), US$703,463.60 for Strategy 3 (SM and natalizumab) and US$670,985.24 for Strategy 4 (SM and alemtuzumab). The accumulated quality-adjusted life years were 10.49, 10.66, 10.69 and 10.71 for each of the four Strategies 1-4, respectively. The resulting incremental cost-effectiveness ratios were 2,297,141.53 comparing Strategy 2 to Strategy 1, and -1,623,918.00 comparing Strategy 4 to Strategy 3.
CONCLUSION: Strategy 1 was the cost-effective strategy for treatment of relapsing-remitting multiple sclerosis when compared with other strategies.

I am not sure that I can explain this one in terms of how cost-effectiveness was assessed but I think it says that in comparison to giving alemtuzumab, natalizumab, beta interferon or nothing (except symptom management) then nothing is the most-cost effective. Hardly surprising as the symptom control drugs cost "peanuts" and the other DMT cost "an arm and a leg". 

This study panders to the "Lazy Neuro" approach  recently renamed the "DreApproach (see comments from Yesterday). Apparantly you just rap "There....there, we'll get you a nice wheelchair...... Bruv!

I don't buy this, do nothing approach. It shows a real lack of ambition to make a change, We need to think about maintaining Brain Health for All. 

14 comments:

  1. "There....there, we'll get you a nice wheelchair...... Bruv!"

    Never expected I would burst into laughter reading a blog about MS!

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    1. Are there studies that show pwMS are not progressing to use of a wheelchair after 20 years on ifn-b-1a? The jury is still out on Alemtuzumab and natalizumab and long term progression.

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  2. Nothing new here, they forgot to add strategy 0: give them a rope and a chair, this would have won cost-effective hands down. I feel lucky everyday i can run and play boardgames competitively because my neuro offered me alemtuzumab when my mri showed a lights like a Christmas tree.

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  3. It is frightening and opening the door to nightmares where sick people are simply "suppressed".
    But it is not the first study I see for MS with similar cost effectiveness results... You are right, the issue is the cost of drugs for these life-long illness to social securities. A cure treatment, once, would of course be much better perceived.
    Thanks to continue repeating your messages and to advise the patients with "lazy neuros" to go to good ones.

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  4. These figures don't apply to the UK. NICE makes sure all the DMTs are priced at a level so that the cost/QALY comes in at less than ~£36K, i.e. ~$50,000. Now you can see how much more the US is paying for their DMTs.

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  5. Rumour has it Dre has finally been found out and he has to kill his persona! What will Yorkshire do without its rapper, pseudo-scientist, anti-hero, Trumpster, alternativefactser?

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    1. Oh, come on, Don Giovannoni! You're stonewalling me again. You claim to be tough-skinned, yet you have deleted my previous comment that plays tribute to a big movie out this weekend that many of your readers my age are flocking to. It is satire, dude. Everyone will disagree with what I wrote but it'll still give them a chuckle. Lighten up, Don Giovannoni. You're becoming the Donald Trump of MS. You're banning dissentingly entertaining opinions.

      My fanbase wants me to entertain and challenge.

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    2. Yorkshire will celebrate MD as a national hero:-)

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    3. Dre
      I have removed this post from spam (above), but previous spammed comment violated rules of engagement and draws us into a war of words
      Too cryptic to remember 1996.

      Do we care about train spotting 2, even if it is any good. To get insight I can watch Charlie Brooker on film 2017. It has no relevance to MS. Some may Chuckle, other may be offended including me...therefore spam

      Not sure what your fan wants.

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  6. Maybe everybody should be offered HSCT. That would be moe cost-effective.
    Anyway, looking at 20 years is not enough, people with MS have the disease for 30-40-50 years and the worst years come towards the end. And, as always, does this model take into account others who suffer - children, family, friends ( formal and informal) and so on. Extra caregiving costs, years of work lost etc

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    1. If HSCT was the answer, it may be a more cost effective option. DrBen was asked about cost to NHS it was about £40,000 so after a year it would save on alemtuzumab, 2 years natalizumab etc.

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    2. the MS arena is riddled with politics and money, do we need to argue cost effectiveness of HSCT?

      my partner chose NM as an alternative to lemtrada's risk/side effect profile and she (as an otherwise healthy, relatively young and early from diagnosis person with ms) is still to regret that choice.

      do we need to argue the $ of it all? isn't the pollies' job? can we focus on what's better for individual people with MS instead of arguing on the grounds of crap that's not our job to argue?

      there is bigger crap to argue about: can we focus on the bigger crap? :)

      ps. i have been following ocrelizumab as a treatment that may benefit my partner at some undefined point in time in future when nm hsct efficacy runs its course (and how do we catch this point before permanent damage occurs).

      if ocrelizumab was an induction treatment we would be somewhere, but asking a person with a history of breast cancer to live without b cells for an undefined period of time (5 years? 6 years? - how long until something more meaningful comes along) - is unrealistic. her b cells returned to normal 12 months post hsct (for better or for worse) and no one can tell me if the breast cancer incidence in ocrelizumab trials are just one of those clusters that mean nothing or if there is something about ocrelizumab (or even if ocrelizumab is more likely to lead to breast cancer for someone with a genetic and hormonal predisposition than rituximab)

      maybe some of our cancer woes would be solved by figuring out how ocrelizumab could be used as an induction treatment: but until those questions can be answered.... why are you arguing about money???

      you and we have enough crap to deal with :)

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    3. ps. speaking of money, if my partner needed rituximab in the next few years before ocrelizumab becomes available in aus, it would be out of pocket at about $2-3k a pop... isn't life swell :)

      ps. in the 2014 blog entry where prof g lamented that a trial is needed to see if rituximab would lessen the overshooting b cells from lemtrada being associated with secondary autoimmunity (http://multiple-sclerosis-research.blogspot.com/2014/11/clinicspeak-derisking-alemtuzumab.html) he was unwilling to concede that hsct may cause lesser secondary autoimmunity at the time (i suggest that the data is there, but don't want to argue the point)... in any event, should i feel better because my partner received a small dose of rituximab post nm hsct (which could lessen the secondary autoimmunity, maybe) or should i despair because no one is monitoring the recipients for such issues?

      meh. tysabri, lemtrada, ocrelizumab or nm hsct: all i can say at this point is: thank god we are in a position to make our own choices and MEH at whatever those choices are.

      PS. thank you for the entry entitled All Antibodies are the same- think again!

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