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Cost effectiveness of rituximab and mycophenolate mofetil for neuromyelitis optica spectrum disorder in Thailand: Economic evaluation and budget impact analysis.

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  • المؤلفون: Aungsumart S;Aungsumart S; Apiwattanakul M; Apiwattanakul M
  • المصدر:
    PloS one [PLoS One] 2020 Feb 12; Vol. 15 (2), pp. e0229028. Date of Electronic Publication: 2020 Feb 12 (Print Publication: 2020).
  • نوع النشر :
    Journal Article; Research Support, Non-U.S. Gov't
  • اللغة:
    English
  • معلومة اضافية
    • المصدر:
      Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
    • بيانات النشر:
      Original Publication: San Francisco, CA : Public Library of Science
    • الموضوع:
      Cost-Benefit Analysis* ; Drug Costs*; Mycophenolic Acid/*economics ; Neuromyelitis Optica/*epidemiology ; Rituximab/*economics; Azathioprine/therapeutic use ; Drug Resistance ; Health Care Surveys ; Humans ; Markov Chains ; Mycophenolic Acid/therapeutic use ; Neuromyelitis Optica/diagnosis ; Neuromyelitis Optica/drug therapy ; Patient Outcome Assessment ; Quality-Adjusted Life Years ; Rituximab/therapeutic use ; Thailand/epidemiology
    • نبذة مختصرة :
      Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory condition of the central nervous system. The extent of disability depends on the severity of the disease and the number of relapses. Although azathioprine is currently the main treatment for patients with NMOSD in Thailand, patients often relapse during its use. Hence, it is argued that there are other drugs that would be more effective. The purpose of this study is to evaluate, from a societal perspective and from the economic impact on Thailand's healthcare system, the cost utility of treatment with mycophenolate mofetil (MMF) and rituximab in patients resistant to azathioprine. The Markov model with a one-year cycle length was applied to predict the health and cost outcomes in patients with NMOSD over a lifetime. The results showed that rituximab exhibited the highest quality-adjusted life year (QALY) gains among all the options. Among the rituximab-based treatments, the administration of a rituximab biosimilar with CD27+ memory B cell monitoring proved to be the most cost-effective option. At the willingness-to-pay threshold of 160,000 Thai baht (THB), or 5,289 US dollar (USD), per QALY gained, the treatment exhibited the highest probability of being cost effective (48%). A sensitivity analysis based on the adjusted price of a generic MMF determined that the treatment was cost effective, exhibiting an incremental cost-effectiveness ratio of -164,653 THB (-5,443 USD) and a 32% probability of being cost effective. The calculated budget impact of treating patients resistant to conventional therapy was 1-6 million THB (33,000-198,000 USD) for the first three years, while after the third year, the budget impact stabilized at 3-4 million THB (99,000-132,000 USD). These data indicate that, in Thailand, treatment of drug resistant NMOSD with a rituximab biosimilar with CD27+ memory B cell monitoring or treatment with a generic MMF would be cost effective and would result in a low budget impact. Therefore, the inclusion of both the rituximab biosimilar and a generic MMF in the National Drug List of Essential Medicine for the treatment of NMOSD may be appropriate.
      Competing Interests: The authors have declared that no competing interests exist.
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    • الرقم المعرف:
      4F4X42SYQ6 (Rituximab)
      HU9DX48N0T (Mycophenolic Acid)
      MRK240IY2L (Azathioprine)
    • الموضوع:
      Date Created: 20200213 Date Completed: 20200511 Latest Revision: 20200511
    • الموضوع:
      20250114
    • الرقم المعرف:
      PMC7015451
    • الرقم المعرف:
      10.1371/journal.pone.0229028
    • الرقم المعرف:
      32050011