Table 10 Cost-effectiveness Outcomes: Multiple Sclerosis
Authors, Year | Type of Analysis/ | Type of Costs | Costs | Type of effectiveness outcome | Effectiveness | ICER (definition): | ICER (result) | Sensitivity Analysis Used | Sensitivity analysis result: | Authors conclude (Reviewer comments where these differ from authors) |
|---|---|---|---|---|---|---|---|---|---|---|
Bogosian et al. 2015 [36*] | CEA and CUA | Total costs at baseline | Intervention: £3080; Control: £3703 | Mean GHQ score (SD) at baseline, end and follow-up | Intervention: 16.10 (6.35) at baseline, 11.43 (4.55) at end, 9.33 (5.02) at follow-up; GHQ changed 17.29 (4.89) at baseline, 14.87 (5.94) at end, 15.17 (4.42) at follow-up; Mean GHQ scores were lower (better) in the mindfulness group compared to the waiting-list group at both the post-intervention and three-month follow-up. | ICER (cost per change in GHQ score) | Intervention dominates | Bootstrapping (Y/N; replications): | Y (1000 iterations). | Skype intervention likely to be cost effective in terms service costs |
Mean difference in total costs at 20 week follow up | –£2285 (95% CI − 5003 to 579); Not statistically significant | Mean difference in QALYs (adjusted for baseline scores) as measured by EQ-5D | −0.006 (95% CI − 0.039 to 0.027). No significant differences in QALYs between the groups. | ICER (cost per QALY gained) | Unclear (intervention either dominates or is extendedly dominated). | Probability treatment is cost effective at WTP threshold(s) | 87.4% probability intervention “saves money and improves outcomes” (no WTP reported). | |||
Mean difference in health and social care costs at 20 week follow up | −£720 (95% confidence interval (CI) –£2636 to £1196) | Probability treatment is cost effective at WTP threshold(s) | 90% chance mindfulness is most cost-effective option at a threshold of £20,000, although many iterations lie within south west quadrant. | |||||||
Informal care costs | Higher for the waiting list group. | |||||||||
Humphreys et al. 2013 [52*] | CEA (CUA not performed as no between group significant difference in EQ-5D at any time point) | Costs per patient over 8 month follow up: | Intervention: -£378 per respondent Control: £ + 297 per patient Mean reduction in costs between intervention and control: −£401 | Mean (SD) BDI | Intervention: −2.38 (4.72); Control: −0.67 (3.44); Statistically significant difference (p = 0.01) in the point reduction in the BDI between the intervention and control group over eight months (mean difference − 1.70, 95% confidence interval − 3 to − 0.4 using Levene’s test for equality). | ICER (cost per additional point reduction in BDI score) | The adjustment group was associated with an incremental cost effectiveness ratio of £118 per additional point reduction in BDI score. | Bootstrapping (Y/N; replications): | Bootstrapping (1000 replications) | Cost-effective in the short term (depends on WTP for a change in BDI score) |
Intervention costs (added to medication and recourse use, components included salary of those involved in group and room costs) | Intervention: £248 per participant; Control: N/A | Mean (SD) utility score on EQ-5D | Intervention: 0.53 (0.30); Control: 0.53 (0.28); Differences between the groups were not statistically significant at any time point | Probability treatment is cost effective at WTP threshold(s) | a 93% probability that the adjustment group will be considered cost effective if purchasers are willing to pay up to £118 per point reduction in BDI score. | |||||
Mosweu et al. 2017 [79*] | CUA | Mean costs at follow up (health and social care perspective): | Intervention: £7331; Control: £5026; Mean difference (when adjusted for baseline costs) was not statistically significant (bootstrapped 95% CI, −£187 to 3771) | Mean improvement in GHQ-12 score | Intervention: 2.69; Control: 1.97; Difference (1.9572) was statistically significant (bootstrapped 95% CI −5.41 to −1.05) | ICER (cost per improvement in GHQ-12 score) | £821 (health and social care perspective), £1242 (societal perspective). | WTP Threshold | Using a £20,000 per QALY gained threshold | Not cost-effective. |
Difference in mean costs (societal perspective) | £2871; Not statistically significant (bootstrapped 95%CI: −£2028 to £7793) | QALYs gained at 12 months | 0.6627 vs. 0.6197. Difference (0.0053) was not statistically significant (bootstrapped 95% CI, −0.059 to 0.103) | ICER (cost per QALY gained) | £303,774 (health and social care perspective); £541,698 (societal perspective). | Probability treatment is cost effective at WTP threshold(s) | 9% probability of being cost effective | |||
CEA/CUA (EQ-5D basecase and SF-6D sensitivity analysis) | Cost per iteration of FACETS | £3625.00 | Mean difference in Global Fatigue score | −0.36 (95% CI:−0.63 to −0.08) | ICER (cost per 1-point improvement in fatigue score using the Global Fatigue Score - GFS) | £1259 | The cost-effectiveness case is equivocal | |||
Estimated cost per person for FACETS (assuming group size of 8) | £453 | QALYs gained | No significant differences between groups | ICER (cost per additional person with a clinically significant improvement in fatigue measured on global fatigue score -GFS) | £2157 | |||||
ICER (cost per QALY gained) | Intervention is dominated (no significant QALY gain). |