Health Economic Models for Relapsing-Remitting Multiple Sclerosis

The structure of the economic models to assess the cost-effectiveness of disease-modifying treatments (DMTs) for relapsing-remitting multiple sclerosis (RRMS) has converged over time. The clinical course of the disease is characterized by changes in disability measured by the Expanded Disability Status Scale (EDSS) and the occurrence of relapse over time.
In this thesis, I demonstrated that the time to complete the Timed 25-Foot Walk (T25FW) test for ambulatory function significantly contributes additional information on health utility in people with RRMS and secondary-progressive MS (SPMS), otherwise not captured by EDSS and relapses. These findings support the use of T25FW to supplement the EDSS and relapses in the characterization of the clinical course of the disease and the accrual of quality-adjusted life-years (QALYs) in economic models of DMTs for RRMS.
A new economic modeling framework was developed using discretely integrated condition event (DICE) simulation to assess the cost-effectiveness of DMTs for RRMS, with the addition of T25FW, while appropriately capturing the correlation of changes between the EDSS, T25FW, and relapses over time. Comparing the cost-effectiveness of two DMTs when T25FW was accounted vs. not accounted for demonstrated that the addition of T25FW has an important impact on QALYs and the cost-effectiveness of DMTs.