Identification of the most cost-saving disease-modifying therapies and factors affecting the budget in the pharmacotherapy of multiple sclerosis: a systematic review.

Abstract

Multiple sclerosis (MS) is an immune-mediated disease that has a considerable health-related quality of life interference. Various disease-modifying therapies (DMTs) in MS management have been approved by the Food and Drug Administration or are currently used off-label. DMTs aim to slow down the progression of MS and decrease the frequency of relapses. This systematic review aimed to evaluate the budget impact of DMTs worldwide. A systematic search query was made to identify related articles in scientific databases. Eligible papers included their characteristics and model inputs, and results were extracted and reported. To critique the standard reporting of studies, a 32-item quality assessment checklist was used. From 1865 records, 22 original budget-impact analyses (BIAs) were included. All BIAs were accepted in the quality assessment (Mean score: 84.4). The most used DMT was β-interferons and natalizumab among novel DMTs. The results of BIAs were highly sensitive to the route of administration, costs of side effects and administration, and presence of biosimilars. However, glatiramer acetate has not experienced significant discounts was the most reported budget-saving DMT. From the results, it can be concluded the budget impact of DMTs in managing symptoms and improving the quality of life of MS patients according to the setting included in the modeling and according to specific conditions and context is different and significantly affects the results of BIAs. For accurate predictions of the effects of DMTs on the distribution of budgets in the MS population, more specific BIAs with higher quality should be done.