Costo-efectividad del tratamiento con interferón beta en pacientes con síndrome clínico aislado de alto riesgo en Colombia / The cost-effectiveness of interferon beta treatment in patients with a clinically isolated syndrome in Colombia

Introducción. En 85 % de los pacientes con esclerosis múltiple se presenta como manifestación inicial un primer evento desmielinizante o síndrome clínico aislado. En estos casos, el tratamiento con interferón beta retrasa hasta dos años la progresión a esclerosis múltiple. Sin embargo, en Colombia este medicamento es costoso. Objetivo. Determinar si el tratamiento del síndrome clínico aislado con interferón beta es costo-efectivo al retrasar la esclerosis múltiple en dos años. Materiales y métodos. Se realizó un análisis de costo-efectividad empleando un árbol de decisiones basado en la perspectiva del paciente y la sociedad. A partir de una revisión sistemática de la literatura y de conceptos de expertos se definieron las diversas probabilidades. Los costos de la enfermedad se calcularon por medio de la revisión de historias y la aplicación de encuestas a los pacientes atendidos en el Hospital Universitario San Ignacio. Para controlar la incertidumbre se realizó un análisis de sensibilidad mediante una simulación de Monte Carlo con mil pacientes. Resultados. El costo del tratamiento con interferón sobrepasa los Col$ 95´000.000 (US$ 50.000) por paciente durante los dos años. Aproximadamente, 80 % corresponde a los costos del medicamento. El costo de la recaída se acerca a Col$ 39´139.200 (US$ 21.744), y los costos indirectos corresponden a Col$ 10´958.400 (US$ 6.088). La tasa representativa del mercado fue de Col$ 1.800. Con el tratamiento se ganan sólo 0,06 años de vida ajustados por discapacidad (AVAD) adicionales. La razón de costo-efectividad ‘incremental´ (sic.) supera el umbral, incluso en el análisis de sensibilidad. Conclusión. La administración de interferón beta en pacientes con síndrome clínico aislado de alto riesgo en los primeros dos años no es costo-efectiva en Colombia.

Introduction: Approximately 85% of patients with multiple sclerosis have an initial demyelinating event. Treatment with interferon beta delays the progression of multiple sclerosis for nearly two years in patients with a clinically isolated syndrome. In Colombia, interferon is very expensive when compared to other countries. Objective: We sought to determine the cost-effectiveness of a two-year interferon beta treatment within Colombia in patients with a clinically isolated syndrome. Materials and methods: Based on patient and society perspectives, a cost-effectiveness analysis was conducted using a decision tree. A variety of probabilities were defined after a systematic review of the available literature. The disease costs were calculated by reviewing medical charts at the Hospital San Ignacio University and surveys completed by multiple sclerosis patients. To control for uncertainty in these data, analysis of approximately one-thousand patients was performed using Monte Carlo methods. Results: The two-year treatment cost per patient exceeds Col$ 95,000,000 (US$ 50,000). Approximately 80 % of this cost corresponds to medications (US$ 40,500). The price of relapse and indirect costs totals Col$ 41,632,149 (US$ 21,744) and Col$ 11,656,389 (US$ 6,088), respectively. Treatment represents an increase of 0.06 quality-adjusted life years (QALY). The incremental cost-effectiveness ratio exceeds the threshold, regardless of the use of Monte Carlo methods for analysis. Conclusion: Administering interferon beta over the course of two years to high-risk patients with a clinically isolated syndrome is not cost-effective within Colombia.

[Usage and costs of treatment with beta interferon among patients with multiple sclerosis in Fars province]

Introduction: Multiple Sclerosis is an inflammatory and demyelinating disease of central nervous system. It is the second most common cause of disability in young adults after trauma. Nowadays, Beta-Interferons are used as the best choice of disease modifying therapy in patients with relapsing-remitting multiple sclerosis. There is a remarkable difference in the uses of these medications between developed and developing countries. The purpose of this study was to evaluate the rate and costs of treatment with Beta-Interferon in patients with MS in Fars Province

Methods: In a descriptive study, all patients who were registered in Shiraz multiple sclerosis society, and were treated with Beta-Interferon [confirmed by the MS Committee of Shiraz University of Medical Sciences] were recruited to the study

Results: A total of 1791 patients had received Beta-Interferon. The most and the least types of the medications used by the patients were Cinovex [28%] and Resigen [2.9], respectively. Many patients [No=587; 33.1%] used Iranian brand of interferon [Cinovex and Recigen] and 1185 patients [67.9%] used medications made in other countries. Prescription of Iranian brands of medications was considerably increased from 2006 to 2010. The annual costs of treatment with Beta-interferon were approximately 126 milliard Rials

Conclusion: A Majority of the MS patients used Beta-Interferon in Fars Province. In recent years, usage of Iranian brand of beta interferon has been largely increased. Despite this fact, more than half of Iranian patients received Beta-Interferons which were made in other countries. Annual cost of these medications was high [more than 126 milliard Rials] in Fars province