Hughes, S.L., Prettyjohns, M.J., Snowden, J.A. orcid.org/0000-0001-6819-3476 et al. (1 more author) (2024) Economics of hematopoietic stem cell transplant in immune-mediated neurologic autoimmune diseases. In: Inglese, M. and Mancardi, G.L., (eds.) Hematopoietic Stem Cell Transplantation for Neurologic Diseases. Handbook of Clinical Neurology, 202 . Elsevier , pp. 279-294. ISBN 9780323902427
Abstract
Autologous hematopoietic stem cell transplantation (AHSCT) is a therapeutic procedure for autoimmune diseases which suppresses inflammation and resets the immune system, thereby halting disease activity and disability progression in treatment-resistant patients. This chapter reviews existing guidelines and health economic evaluations of AHSCT for multiple sclerosis (MS) and presents a cost-utility analysis from the UK NHS and personal social services perspective comparing AHSCT with disease-modifying therapies (DMTs) in patients with highly active relapsing-remitting MS (RRMS) based on the only published randomized controlled trial, “MIST,” in this population. Over a 5-year time horizon, AHSCT was dominant (more effective and less costly) over the DMTs in MIST. At a threshold of £20,000 per QALY, there was a 100% probability that AHSCT was cost-effective. This result is explained by the high ongoing costs of DMTs compared with the up-front cost of AHSCT, combined with the high effectiveness of AHSCT. When compared with natalizumab, the result did not change; AHSCT remained dominant. These results support current guideline recommendations regarding AHSCT for highly active RRMS. The cost-effectiveness of AHSCT in progressive and aggressive MS and other immune-mediated neurologic diseases remains uncertain due to a lack of health economic analyses, reflecting the limited clinical evidence base.
Metadata
Item Type: | Book Section |
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Authors/Creators: |
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Editors: |
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Copyright, Publisher and Additional Information: | © 2024 Elsevier B.V. |
Keywords: | Disease-modifying therapy; Hematopoietic stem cell transplantation; Incremental cost-effectiveness ratio; Multiple sclerosis; Quality-adjusted life year; Relapsing-remitting multiple sclerosis; Humans; Hematopoietic Stem Cell Transplantation; Cost-Benefit Analysis; Autoimmune Diseases of the Nervous System |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 19 Sep 2024 16:12 |
Last Modified: | 19 Sep 2024 16:12 |
Status: | Published |
Publisher: | Elsevier |
Series Name: | Handbook of Clinical Neurology |
Refereed: | Yes |
Identification Number: | 10.1016/b978-0-323-90242-7.00007-9 |
Related URLs: | |
Sustainable Development Goals: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:217246 |