Cost-Effectiveness Analysis of Cannabinoid Oromucosal Spray Use for the Management of Spasticity in Subjects with Multiple Sclerosis

• Published in: Clinical drug investigation Vol. 40; no. 4; pp. 319 - 326
• Main Authors: Mantovani, Lorenzo G., Cozzolino, Paolo, Cortesi, Paolo A., Patti, Francesco
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.04.2020; Springer Nature B.V
• Subjects: Adult; Autoimmune diseases; Cannabidiol - administration & dosage; Cost analysis; Cost-Benefit Analysis; Disability; Disease; Dronabinol - administration & dosage; Drug Combinations; Female; Humans; Internal Medicine; Intervention; Italy; Male; Medicine; Medicine & Public Health; Middle Aged; Multiple sclerosis; Multiple Sclerosis - drug therapy; Muscle Spasticity - drug therapy; Original Research Article; Patients; Pharmacology/Toxicology; Pharmacotherapy; Quality of Life; Quality-Adjusted Life Years; Spasticity; Treatment resistance; Italy
• ISSN: 1173-2563; 1179-1918; 1179-1918
• DOI: 10.1007/s40261-020-00895-6

Introduction Multiple sclerosis (MS) is a highly symptomatic disease, with a wide range of disabilities affecting many bodily functions, even in younger persons with a short disease history. The availability of a cannabinoid oromucosal spray (Sativex) for the management of treatment-resistant MS spasticity has provided a new opportunity for many patients. Objective Our study aimed to assess the cost effectiveness of Sativex in Italian patients with treatment-resistant MS spasticity. The analysis was based on the real-world data of a large registry of Italian patients. Methods A cost-utility analysis was conducted using data collected prospectively from an electronic registry of all patients who began to use Sativex for MS-resistant spasticity between January 2014 and February 2015 in 30 specialized MS units across Italy and were followed up for ≤ 6 months. Data on drug consumption and spasticity/utility were used to estimate the incremental cost-effectiveness ratio (ICER) of Sativex, as compared with no intervention. No costs or spasticity/utility changes were assumed for no treatment intervention. The ICER was expressed as quality-adjusted life-years (QALYs) gained, using the Italian NHS perspective and a 6-month time horizon. Results Sativex effectiveness and consumption was estimated analyzing data of 1350 patients from the registry. These patients reported a mean (SD) utility increment of 0.087 (0.069) after 1 month of treatment, 0.118 (0.073) after 3 months’ treatment and 0.127 (0.080) after 6 months’ treatment. The 6-month cost of treating the entire population with Sativex was €1,361,266, with a €1008 cost and 0.0284 QALYs gained per patient. The estimated ICER was €35,516 per QALY gained, with little variability around the central estimate of cost-effectiveness, as shown by the cost-effectiveness acceptability curve. Conclusion The use of Sativex could improve the quality of life of patients with a reasonable incremental cost resulting as a cost-effective option for patients with MS-resistant spasticity. These results could help clinicians and decision makers to develop improved management strategies for spasticity in patients with MS, optimizing the use of available resources.