<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1130-6343</journal-id>
<journal-title><![CDATA[Farmacia Hospitalaria]]></journal-title>
<abbrev-journal-title><![CDATA[Farm Hosp.]]></abbrev-journal-title>
<issn>1130-6343</issn>
<publisher>
<publisher-name><![CDATA[Grupo Aula Médica]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1130-63432020000200007</article-id>
<article-id pub-id-type="doi">10.7399/fh.11385</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Disease modifying therapies in multiple sclerosis: cost-effectiveness systematic review]]></article-title>
<article-title xml:lang="es"><![CDATA[Terapias modificadoras de la enfermedad en esclerosis múltiple: revisión sistemática de costo-efectividad]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Navarro]]></surname>
<given-names><![CDATA[Cristian Eduardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ordóñez-Callamand]]></surname>
<given-names><![CDATA[Eliana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alzate]]></surname>
<given-names><![CDATA[Juan Pablo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Nacional de Colombia School of Medicine Unit of Clinical Neurology, Department of Medicine]]></institution>
<addr-line><![CDATA[Bogotá ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad Nacional de Colombia Grupo de Investigación en Neurología ]]></institution>
<addr-line><![CDATA[Bogotá ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad Nacional de Colombia School of Medicine Unit of Internal Medicine, Department of Medicine]]></institution>
<addr-line><![CDATA[Bogotá ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Universidad Nacional de Colombia School of Medicine Instituto de Investigaciones Clínicas]]></institution>
<addr-line><![CDATA[Bogotá ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>04</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>04</month>
<year>2020</year>
</pub-date>
<volume>44</volume>
<numero>2</numero>
<fpage>68</fpage>
<lpage>76</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S1130-63432020000200007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S1130-63432020000200007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S1130-63432020000200007&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Objective: To identify and describe cost-effectiveness studies that eva luate disease modifying therapies in the context of relapsing-remitting mul tiple sclerosis.  Method: A systematic review of the literature was carried out by searching MEDLINE, Embase, the Cochrane Library, LILACS, the Tufts Medical Center Cost-Effectiveness Analysis Registry, the National Health Service Economic Evaluation Database and Open Grey. The search was performed in January 2018 and covered articles published between January 2010 and December 2017. The studies reviewed were payer-perspective cost-effectiveness analy ses for interferon beta-1 a, interferon beta-1 b, glatiramer acetate, teriflunomide, fingolimod, dimethyl fumarate, natalizumab, alemtuzumab and rituximab. The Quality of Health Economic Studies instrument was used to determine the quality of the studies reviewed. Risk of bias was assessed without a standar dized tool. An analysis was made of direct costs, quality-adjusted life-years and the incremental cost-effectiveness ratio. Data extraction and evaluation of information were conducted separately by each author.  Results: Four hundred one references were found; nine studies were included. A great degree of variability was identified for several methodo logical aspects. Two studies that applied the incremental cost-effec tiveness ratio (cost) showed no first-line therapy to be cost-effective. A third study demonstrated dominance of interferon beta-1 b over placebo (USD -315,109.45) and a fourth paper showed dominance of teriflunomide over interferons and glatiramer acetate (USD -121,840.37). As regards second-line therapies, dimethyl fumarate was cost-effective in a study that compared it to glatiramer acetate and interferon beta-1a and it was dominant in another study that compared it with glatiramer ace tate (USD -158,89793) and fingolimod (USD -92,988.97). In the third line of treatment, one study showed natalizumab to be cost-effective as compared with fingolimod, and another study showed alemtuzumab to be dominant over fingolimod (USD -49,221). A third trial demonstrated alemtuzumab to be dominant over natalizumab (USD -1,656,266.07). Many of the trials have sponsorship bias. Eight of the trials received a high QHES score.  Conclusions: The present paper shows that cost-effectiveness studies have high levels of methodological variability, some of them reaching contradictory results. As a result, it is not possible to determine which di sease-modifying therapy is really cost-effective in the context of relapsing-remitting multiple sclerosis.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Objetivo: Identificar y describir los estudios de costo-efectividad que evalúan las terapias modificadoras de la enfermedad en esclerosis múlti ple recurrente-remitente.  Método: Revisión sistemática de la literatura en MEDLINE, Embase, Co chrane Library, LILACS, Tufts Medical Center cost-effectiveness analysis registry, National Health Service economic evaluation database y Open Grey; búsqueda limitada entre enero de 2010 y diciembre de 2017, se ejecutó en enero de 2018. Se incluyeron modelos de costo-efectividad con perspectiva de pagador para interferón beta-1a, interferón beta-1b, acetato de glatiramero, teriflunomida, fingolimod, dimetilfumarato, natalizumab, alem tuzumab y rituximab. La herramienta Quality of Health Economic Studies fue usada para determinar la calidad de los estudios, el sesgo se evaluó sin una herramienta estandarizada, dada su no existencia. Se analizaron costos directos, años de vida ajustados por calidad y la razón de costo-efectividad incremental. La extracción de los datos y la evaluación de la información se realizaron por cada autor de forma independiente.  Resultados: Se encontraron 401 referencias, se incluyeron nueve es tudios; hubo variabilidad en múltiples aspectos metodológicos. Según la razón de costo/efectividad incremental (costo), dos trabajos mostraron que ninguna terapia de primera línea fue costo-efectiva, un tercer estudio repor ta al interferón beta-1b como dominante sobre placebo (-315.109,45 dólar estadounidense (US$)) y un cuarto artículo expone a teriflunomida como dominante sobre interferones y acetato de glatiramero (-121.840,37 US$). Respecto a las terapias de segunda línea, dimetil fumarato fue costo-efectivo en un estudio comparado con acetato de glatiramero e interferón beta-1a y fue dominante en otro trabajo frente a acetato de glatiramero (-158.897,93 US$) y fingolimod (-92.988,97 US$). En la tercera línea de tratamiento, natalizumab fue costo-efectivo sobre fingolimod en un ar tículo, y alemtuzumab fue dominante contra fingolimod (-49.221 US$) en un segundo estudio. En un tercer ensayo el alemtuzumab fue dominante sobre natalizumab (-1.656.266,07 US$). Muchos estudios tuvieron sesgo de patrocinador. Ocho artículos obtuvieron alta puntuación de calidad con la herramienta Quality of Health Economic Studies.  Conclusiones: Este trabajo demuestra que existe una gran variabilidad metodológica entre los estudios de costo-efectividad, y algunos de ellos tienen resultados contradictorios. No es posible determinar qué terapia mo dificadora de la enfermedad en esclerosis múltiple recurrente-remitente es costo-efectiva.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Cost-effectiveness analysis]]></kwd>
<kwd lng="en"><![CDATA[Quality-adjusted life-years]]></kwd>
<kwd lng="en"><![CDATA[Multiple sclerosis]]></kwd>
<kwd lng="en"><![CDATA[Incremental cost-effectiveness ratio]]></kwd>
<kwd lng="en"><![CDATA[Systematic review]]></kwd>
<kwd lng="en"><![CDATA[Disease-modifying therapy]]></kwd>
<kwd lng="es"><![CDATA[Análisis de costo-efectividad]]></kwd>
<kwd lng="es"><![CDATA[Años de vida ajustados por calidad]]></kwd>
<kwd lng="es"><![CDATA[Esclerosis múltiple]]></kwd>
<kwd lng="es"><![CDATA[Razón de costo-efectividad incremental]]></kwd>
<kwd lng="es"><![CDATA[Revisión sistemática]]></kwd>
<kwd lng="es"><![CDATA[Terapia modificadora de la enfermedad]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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