Funding for beta-interferon would be better spent on other ways of improving quality of life for patients with secondary progressive multiple sclerosis, says a group of Scottish researchers. “Realistically, far more benefit would be obtained from directing funds into improved supportive care,” say Dr Raeburn Forbes (department of neurology, Ninewells hospital, Dundee) and colleagues.
They report a cost utility study for patients with secondary progressive multiple sclerosis (British Medical Journal 1999;319:1529). They identified 132 patients who had the disease but were not yet wheelchair-bound and compared the effect of treating these patients with interferon beta-1b for 30 months with the efficacy of existing best practice that did not use the drug. Dr Forbes et al estimate that the number needed to treat for 30 months to delay time to wheelchair dependence in one person by nine months was 18 (95 per cent confidence interval 5 to 26). The net cost per quality adjusted life year (QALY) gained from treatment with beta-interferon was £1,024,393 (95 per cent CI £276,191 to £1,484,824).
Targeting patients with more active disease seemed to be more efficient than treating all patients with secondary progressive multiple sclerosis but the opportunity cost was still substantial. The researchers conclude that it would be better to allocate more resources to people with secondary progressive multiple sclerosis but that access to interferon beta-1b should be restricted.
The Multiple Sclerosis Society has expressed concern over the findings of the study. Mr Peter Cardy, (chief executive) said: “The Society believes very strongly that clinical care must be additional to drug therapies and not an alternative to them.” Neurologists “should not have to make treatment judgments on the basis of what’s in the piggy bank,” he said.