Systematic Review of the Costs and Benefits of Prescribed Cannabis-Based Medicines for the Management of Chronic Illness: Lessons from Multiple Sclerosis

Samuel Herzog (), Marian Shanahan (), Peter Grimison (), Anh Tran (), Nicole Wong (), Nicholas Lintzeris (), John Simes (), Martin Stockler () and Rachael L. Morton ()
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Samuel Herzog: NHMRC Clinical Trials Centre, The University of Sydney
Marian Shanahan: The University of New South Wales
Peter Grimison: Chris O’Brien Lifehouse
Anh Tran: NHMRC Clinical Trials Centre, The University of Sydney
Nicole Wong: NHMRC Clinical Trials Centre, The University of Sydney
Nicholas Lintzeris: The University of Sydney
John Simes: NHMRC Clinical Trials Centre, The University of Sydney
Martin Stockler: NHMRC Clinical Trials Centre, The University of Sydney
Rachael L. Morton: NHMRC Clinical Trials Centre, The University of Sydney

PharmacoEconomics, 2018, vol. 36, issue 1, No 8, 67-78

Abstract: Abstract Introduction Cannabis-based medicines (CBMs) may offer relief from symptoms of disease; however, their additional cost needs to be considered alongside their effectiveness. We sought to review the economic costs and benefits of prescribed CBMs in any chronic illness, and the frameworks used for their economic evaluation. Methods A systematic review of eight medical and economic databases, from inception to mid-December 2016, was undertaken. MeSH headings and text words relating to economic costs and benefits, and CBMs were combined. Study quality was assessed using relevant checklists and results were synthesised in narrative form. Results Of 2514 identified records, ten studies met the eligibility criteria, all for the management of multiple sclerosis (MS). Six contained economic evaluations, four studies reported utility-based quality of life, and one was a willingness-to-pay study. Four of five industry-sponsored cost–utility analyses for MS spasticity reported nabiximols as being cost-effective from a European health system perspective. Incremental cost-effectiveness ratios per quality-adjusted life-year (QALY) gained for these five studies were £49,257 (UK); £10,891 (Wales); €11,214 (Germany); €4968 (Italy); and dominant (Spain). Nabiximols for the management of MS spasticity was not associated with statistically significant improvements in EQ-5D scores compared with standard care. Study quality was moderate overall, with limited inclusion of both relevant societal costs and discussions of potential bias. Conclusions Prescribed CBMs are a potentially cost-effective add-on treatment for MS spasticity; however, this evidence is uncertain. Further investment in randomised trials with in-built economic evaluations is warranted for a wider range of clinical indications. Systematic review registration PROSPERO Registration Number: CRD42014006370.

Date: 2018
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DOI: 10.1007/s40273-017-0565-6

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