Multiple sclerosis, ICER, simulations, credibility, replication, daclizumab, alemtuzumab, natalizumab


On January 26, 2017, the Institute for Clinical and Economic Review (ICER) posted its final report on treatments for multiple sclerosis (MS) with disease modifying therapies (DMTs). The objective was to provide a modeled assessment of the effectiveness and value of the various DMTs against each other and supportive care. The model considered both relapsing-remitting and primary-progressive MS with hypothetical patient cohorts tracked from therapy initiation to death in a lifetime cost-utility framework. Recommendations were made for possible DMT package price discounts given benchmark willingness-to-pay cost per QALY thresholds. The purpose of this commentary is to assess this modeled analysis from the criteria of normal science: are the claims presented for the competing DMTs credible, evaluable and replicable? The review concludes that the ICER model does not meet required standards. The claims made for comparative effectiveness and value are non-evaluable. They are immune to failure. The review concludes that if models are to contribute to improving our understanding of the effectiveness and costs of DMTs then they should be evaluable in the short-term to allow feedback to formulary committees in a meaningful timeframe.

Conflict of Interest