The Assessment for Disinvestment of Intramuscular Interferon Beta for Relapsing-Remitting Multiple Sclerosis in Brazil

Livia Lovato Pires de Lemos (), Augusto Afonso Guerra Júnior (), Marisa Santos (), Carlos Magliano (), Isabela Diniz (), Kathiaja Souza (), Ramon Gonçalves Pereira (), Juliana Alvares (), Brian Godman (), Marion Bennie (), Ivan Ricardo Zimmermann (), Vânia Crisitna Canuto Santos (), Clarice Alegre Pretramale () and Francisco de Assis Acurcio ()
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Livia Lovato Pires de Lemos: Universidade Federal de Minas Gerais
Augusto Afonso Guerra Júnior: Universidade Federal de Minas Gerais
Marisa Santos: Núcleo de Avaliação de Tecnologias em Saúde, Instituto Nacional de Cardiologia
Carlos Magliano: Núcleo de Avaliação de Tecnologias em Saúde, Instituto Nacional de Cardiologia
Isabela Diniz: Universidade Federal de Minas Gerais
Kathiaja Souza: Departamento de Gestão e Incorporação de Tecnologias em Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Ministério da Saúde
Ramon Gonçalves Pereira: Universidade Federal de Minas Gerais
Juliana Alvares: Universidade Federal de Minas Gerais
Brian Godman: Karolinska University Hospital Huddinge
Marion Bennie: University of Strathclyde
Ivan Ricardo Zimmermann: Departamento de Gestão e Incorporação de Tecnologias em Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Ministério da Saúde
Vânia Crisitna Canuto Santos: Departamento de Gestão e Incorporação de Tecnologias em Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Ministério da Saúde
Clarice Alegre Pretramale: Departamento de Gestão e Incorporação de Tecnologias em Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Ministério da Saúde
Francisco de Assis Acurcio: Universidade Federal de Minas Gerais

PharmacoEconomics, 2018, vol. 36, issue 2, No 4, 173 pages

Abstract: Abstract In Brazil, inclusion and exclusion of health technologies within the Unified Health System (SUS) is the responsibility of the National Committee for Health Technology Incorporation (CONITEC). A recent Cochrane systematic review demonstrated that intramuscular interferon beta 1a (IFN-β-1a-IM) was inferior to the other beta interferons (IFN-βs) for multiple sclerosis (MS). As a result, CONITEC commissioned an analysis to review possible disinvestment within SUS. The objective of this paper is to describe the disinvestment process for IFN-β-1a-IM in Brazil. The first assessment comprised a literature review and mixed treatment comparison meta-analysis. The outcome of interest was the proportion of relapse-free patients in 2 years. This analysis confirmed the inferiority of IFN-β-1a-IM. Following this, CONITEC recommended disinvestment, with the decision sent for public consultation. More than 3000 contributions were made on CONITEC’s webpage, most of them against the preliminary decision. As a result, CONITEC commissioned a study to assess the effectiveness of IFN-β-1a-IM among Brazilian patients in routine clinical care. The second assessment involved an 11-year follow-up of a non-concurrent cohort of 12,154 MS patients developed by deterministic-probabilistic linkage of SUS administrative databases. The real-world assessment further demonstrated that IFN-β-1a-IM users had a statistically higher risk of treatment failure, defined as treatment switching or relapse treatment or death, with the assessment showing that IFN-β-1a-IM was inferior to the other IFN-βs and to glatiramer acetate in both direct and indirect analysis. In the drug ranking with 40,000 simulations, IFN-β-1a-IM was the worst option, with a success rate of only 152/40,000. Following this, CONITEC decided to exclude the intramuscular presentation of IFN-β from the current MS treatment guidelines, giving patients who are currently on this treatment the option of continuing until treatment failure. In conclusion, we believe this is the first example of this new disinvestment process in action, providing an exemplar for other treatments in Brazil as well as other countries.

Date: 2018
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DOI: 10.1007/s40273-017-0579-0

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