Cost-Effectiveness Analysis of Disease-Modifying Therapies in Multiple Sclerosis

Cost-effectiveness analysis (CEA) of disease-modifying therapies (DMTs) in multiple sclerosis (MS) is central to informed decision-making in healthcare systems worldwide. By comparing the additional cost of a therapy to its health gain—typically expressed in quality-adjusted life years (QALYs)—CEA informs the allocation of finite resources. Economic evaluations often employ Markov models or microsimulation frameworks to characterise disease progression across disability states, using scales such as the Expanded Disability Status Scale (EDSS). Such models simulate long-term horizons, capture relapse rates, incorporate utility values and allow calculation of incremental cost-effectiveness ratios (ICERs). Recent expansions in therapeutic options—from injectable agents through oral fumarates to monoclonal antibodies—have increased complexity. Analyses now frequently adopt a societal perspective, integrating direct medical costs, indirect costs such as productivity losses and caregiver burden. Comparative studies examine not only single-agent ICERs but also optimal sequences of DMTs over a patient’s lifetime. Evidence highlights the importance of drug acquisition costs, dosing strategies and durability of efficacy in shaping value. Globally, CEAs guide reimbursement, inform clinical guidelines and foster price negotiations, while remaining sensitive to country-specific settings, willingness-to-pay thresholds and healthcare priorities.

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Cost-Effectiveness Analysis of Disease-Modifying Therapies in Multiple Sclerosis publication trend

The graph below shows the total number of articles in cost-effectiveness analysis of disease-modifying therapies in multiple sclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

Disease-modifying therapy (DMT): A treatment that alters the underlying immunological process in MS to reduce relapses and delay disability.

Quality-adjusted life year (QALY): A composite measure combining duration and quality of life into a single unit for economic evaluation.

Incremental cost-effectiveness ratio (ICER): The additional cost per additional QALY gained when comparing two interventions.

Markov model: A mathematical approach that simulates transitions between defined health states over time to estimate costs and outcomes.

Expanded Disability Status Scale (EDSS): A standardised scale ranging from 0 (normal) to 10 (death) used to quantify disability in MS.

Societal perspective: An economic viewpoint that includes all costs and benefits, direct and indirect, to society as a whole.

References

1. Cost‐Effectiveness of Multiple Sclerosis Disease‐Modifying Therapies: A Systematic Review of the Literature. Autoimmune Diseases (2012).
2. Effectiveness and Cost-Effectiveness of 360 Disease-Modifying Treatment Escalation Sequences in Multiple Sclerosis. Value in Health (2021).
3. Cost-effectiveness analysis of rituximab versus natalizumab in patients with relapsing remitting multiple sclerosis. BMC Health Services Research (2022).
4. Societal economic burden of multiple sclerosis and cost-effectiveness of disease-modifying therapies. Frontiers in Neurology (2022).
5. A forgotten aspect of the NICE reference case: an observational study of the health related quality of life impact on caregivers of people with multiple sclerosis. BMC Health Services Research (2013).