Pegylated versus non-pegylated interferon beta 1a in patients with relapsing-remitting multiple sclerosis: A cost-effectiveness analysis

  • Amir Hashemi-Meshkini Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
  • Hedieh Sadat Zekri Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  • Hasan Karimi-Yazdi School of Medicine, Qom University of Medical Sciences, Qom, Iran
  • Pardis Zaboli Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
  • MohammadAli Sahraian Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  • Shekoufeh Nikfar Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
Keywords: Interferon Beta-1a, ; Multiple Sclerosis, Cost-Benefit Analysis, Iran


Background: Pegylated (PEG) interferon beta 1a has been approved by the United States Food and Drug Administration (USFDA) as an alternative to interferon beta 1a for multiple sclerosis (MS). Due to its higher price, this study aimed to evaluate the cost-effectiveness of PEG-interferon beta 1-a compared with interferon beta 1a from an Iranian payer perspective. Methods: A Markov model was designed according to health states based on Expanded Disability Status Scale (EDSS) and one-month cycles over a 10-year time horizon. Direct medical and non-medical costs were included from a payer perspective. Results: The incremental cost-effectiveness ratio (ICER) was estimated around 11111 US dollars (USD) per quality-adjusted life-year (QALY) gained for the PEG-interferon versus interferon regimen [with currency rate of 29,000 Iranian Rial (IRR) to 1 USD in 2016]. Conclusion: Considering the cost-effectiveness threshold in Iran [three times of gross domestic product (GDP) per capita or 15,945 USD], PEG-interferon beta 1-a could be considered as a cost effective treatment for Iranian patients with MS.


1. Izadi S, Nikseresht A, Sharifian M, Sahraian MA, Hamidian Jahromi A, Aghighi M, et al. Significant increase in the prevalence of multiple sclerosis in Iran in 2011. Iran J Med Sci 2014; 39(2): 152-3.
2. Eskandarieh S, Heydarpour P, Elhami SR, Sahraian MA. Prevalence and incidence of multiple sclerosis in Tehran, Iran. Iran J Public Health 2017; 46(5): 699-704.
3. Etemadifar M, Janghorbani M, Shaygannejad V, Ashtari F. Prevalence of multiple sclerosis in Isfahan, Iran. Neuroepidemiology 2006; 27(1): 39-44.
4. Torabipour A, Asl ZA, Majdinasab N, Ghasemzadeh R, Tabesh H, Arab M. A study on the direct and indirect costs of multiple sclerosis based on expanded disability status scale score in khuzestan, iran. Int J Prev Med 2014; 5(9): 1131-8.
5. Shirani A, Zhao Y, Karim ME, Evans C, Kingwell E, van der Kop ML, et al. Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis. JAMA 2012; 308(3): 247-56.
6. Beer K, Muller M, Hew-Winzeler AM, Bont A, Maire P, You X, et al. The
prevalence of injection-site reactions with disease-modifying therapies and their effect on adherence in patients with multiple sclerosis: An observational study. BMC Neurol 2011; 11: 144.
7. Costello K, Kennedy P, Scanzillo J. Recognizing nonadherence in patients with multiple sclerosis and maintaining treatment adherence in the long term. Medscape J Med 2008; 10(9): 225.
8. Safavi M, Nikfar S, Abdollahi M. A systematic review of drugs in late-stage development for the treatment of multiple sclerosis: A focus on oral synthetic drugs. Inflamm Allergy Drug Targets 2015; 13(6): 351-66.
9. Pan F, Goh JW, Cutter G, Su W, Pleimes D, Wang C. Long-term cost-effectiveness model of interferon beta-1b in the early treatment of multiple sclerosis in the United States. Clin Ther 2012; 34(9): 1966-76.
10. Palace J, Duddy M, Bregenzer T, Lawton M, Zhu F, Boggild M, et al. Effectiveness and cost-effectiveness of interferon beta and glatiramer acetate in the UK Multiple Sclerosis Risk Sharing Scheme at 6 years: A clinical cohort study with natural history comparator. Lancet Neurol 2015; 14(5): 497-505.
11. Dembek C, White LA, Quach J, Szkurhan A, Rashid N, Blasco MR. Cost-effectiveness of injectable disease-modifying therapies for the treatment of relapsing forms of multiple sclerosis in Spain. Eur J Health Econ 2014; 15(4): 353-62.
12. Nikfar S, Kebriaeezadeh A, Dinarvand R, Abdollahi M, Sahraian MA, Henry D, et al. Cost-effectiveness of different interferon beta products for relapsing-remitting and secondary progressive multiple sclerosis: Decision analysis based on long-term clinical data and switchable treatments. Daru 2013; 21(1): 50.
13. Imani A, Golestani M. Cost-utility analysis of disease-modifying drugs in relapsing-remitting multiple sclerosis in Iran. Iran J Neurol 2012; 11(3): 87-90.
14. Nikfar S, Kebriaeezadeh A, Majdzadeh R, Abdollahi M. Monitoring of National Drug Policy (NDP) and its standardized indicators; conformity to decisions of the national drug selecting committee in Iran. BMC Int Health Hum Rights 2005; 5(1): 5.
15. Kurtzke JF. Rating neurologicimpairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 1983; 33(11): 1444-52.
16. Lee S, Baxter DC, Limone B, Roberts MS, Coleman CI. Cost-effectiveness of fingolimod versus interferon beta-1a for relapsing remitting multiple sclerosis in the United States. J Med Econ 2012; 15(6): 1088-96.
17. Sanchez-de la Rosa R, Sabater E, Casado MA, Arroyo R. Cost-effectiveness analysis of disease modifiying drugs (interferons and glatiramer acetate) as first line treatments in remitting-relapsing multiple sclerosis patients. J Med Econ 2012; 15(3): 424-33.
18. Prosser LA, Kuntz KM, Bar-Or A, Weinstein MC. Cost-effectiveness of interferon beta-1a, interferon beta-1b, and glatiramer acetate in newly diagnosed non-primary progressive multiple sclerosis. Value Health 2004; 7(5): 554-68.
19. Bell C, Graham J, Earnshaw S, Oleen-Burkey M, Castelli-Haley J, Johnson K. Cost-effectiveness of four immunomodulatory therapies for relapsing-remitting multiple sclerosis: A Markov model based on long-term clinical data. J Manag Care Pharm 2007; 13(3): 245-61.
20. Earnshaw SR, Graham J, Oleen-Burkey M, Castelli-Haley J, Johnson K. Cost effectiveness of glatiramer acetate and natalizumab in relapsing-remitting multiple sclerosis. Appl Health Econ Health Policy 2009; 7(2): 91-108.
21. Jankovic SM, Kostic M, Radosavljevic M, Tesic D, Stefanovic-Stoimenov N, Stevanovic I, et al. Cost-effectiveness of four immunomodulatory therapies for relapsing-remitting multiple sclerosis: a Markov model based on data a Balkan country in socioeconomic transition. Vojnosanit Pregl 2009; 66(7): 556-62.
22. Hirst C, Ingram G, Pearson O, Pickersgill T, Scolding N, Robertson N. Contribution of relapses to disability in multiple sclerosis. J Neurol 2008; 255(2): 280-7.
23. Kobelt G, Berg J, Lindgren P, Jonsson B, Stawiarz L, Hillert J. Modeling the cost-effectiveness of a new treatment for MS (natalizumab) compared with current standard practice in Sweden. Mult Scler 2008; 14(5): 679-90.
24. Tolley K, Hutchinson M, Pachner A, Kinter E, Sperling B, You X, et al. systematic literature review and network metaanalysis of pegylated interferon beta1a and disease modifying therapies for relapsingremitting multiple sclerosis (P7.234). Proceedings of the 66th Annual Meeting American Academy of Neurology (AAN); 2014 Apr. 26-May 03; Philadelphia, PA.
25. Nikfar S, Rahimi R, Abdollahi M. A meta-analysis of the efficacy and tolerability of interferon-beta in multiple sclerosis, overall and by drug and disease type. Clin Ther 2010; 32(11): 1871-88.
26. Filippini G, Munari L, Incorvaia B, Ebers GC, Polman C, D'Amico R, et al. Interferons in relapsing remitting multiple sclerosis: A systematic review. Lancet 2003; 361(9357): 545-52.
27. Weinshenker BG, Rice GP, Noseworthy JH, Carriere W, Baskerville J, Ebers GC. The natural history of multiple sclerosis: A geographically based study. 3. Multivariate analysis of predictive factors and models of outcome. Brain 1991; 114 (Pt 2): 1045-56.
28. Weinshenker BG. The natural history of multiple sclerosis. Neurol Clin 1995; 13(1): 119-46.
29. Goodkin DE, Hertsgaard D, Rudick RA. Exacerbation rates and adherence to disease type in a prospectively followed-up population with multiple sclerosis. Implications for clinical trials. Arch Neurol 1989; 46(10): 1107-12.
30. Pokorski RJ. Long-term survival experience of patients with multiple sclerosis. J Insur Med 1997; 29(2): 101-6.
31. Gani R, Giovannoni G, Bates D, Kemball B, Hughes S, Kerrigan J. Cost-effectiveness analyses of natalizumab (Tysabri) compared with other disease-modifying therapies for people with highly active relapsing-remitting multiple sclerosis in the UK. Pharmacoeconomics 2008; 26(7): 617-27.
32. Fleurence RL, Hollenbeak CS. Rates and probabilities in economic modelling: Transformation, translation and appropriate application. Pharmacoeconomics 2007; 25(1): 3-6.
33. Calabresi PA, Kieseier BC, Arnold DL, Balcer LJ, Boyko A, Pelletier J, et al. Pegylated interferon beta-1a for relapsing-remitting multiple sclerosis (ADVANCE): A randomised, phase 3, double-blind study. Lancet Neurol 2014; 13(7): 657-65.
34. Ebers GC. Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. PRISMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group. Lancet 1998; 352(9139): 1498-504.
35. Abdoli G. Estimation of social discount rate for Iran. Economic Research Review 2018; 10(3): 135-56. [In Persian].
36. Gallelli L, Palleria C, De Vuono A, Mumoli L, Vasapollo P, Piro B, et al. Safety and efficacy of generic drugs with respect to brand formulation. J Pharmacol Pharmacother 2013; 4(Suppl 1): S110-S114.
37. O'Day K, Meyer K, Mitchell M, Agarwal S, Kinter E. Peginterferon beta-1a reduces relapse-associated costs in patients with relapsing-remitting multiple sclerosis (P4. 146). Neurology 2014; 82(10 Supplement): 4-146.
How to Cite
Hashemi-Meshkini A, Zekri HS, Karimi-Yazdi H, Zaboli P, Sahraian M, Nikfar S. Pegylated versus non-pegylated interferon beta 1a in patients with relapsing-remitting multiple sclerosis: A cost-effectiveness analysis. IJNL. 17(3):123-8.
Original Article(s)