Cost-effectiveness of delayed-release dimethyl fumarate for the treatment of relapsing forms of multiple sclerosis in the United States

<p><b>Objective:</b></p> <p>To assess the cost-effectiveness of delayed-release dimethyl fumarate (DMF, also known as gastro-resistant DMF), an effective therapy for relapsing forms of multiple sclerosis (MS), compared with glatiramer acetate and fingolimod, commonly used treatments in the US.</p> <p><b>Methods:</b></p> <p>A Markov model was developed comparing delayed-release DMF to glatiramer acetate and fingolimod using a US payer perspective and 20-year time horizon. A cohort of patients, mean age 38 years, with relapsing-remitting MS and Kurtzke Expanded Disability Status Scale (EDSS) scores between 0–6 entered the model. Efficacy and safety were estimated by mixed-treatment comparison of data from the DEFINE and CONFIRM trials and clinical trials of other disease-modifying therapies. Data from published studies were used to derive resource use, cost, and utility inputs. Key outcomes included costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Alternative scenarios tested in a sensitivity analysis included drug efficacy, EDSS-related or relapse-related costs, alternative perspectives, drug acquisition costs, and utility.</p> <p><b>Results:</b></p> <p>Base-case results with a 20-year time horizon indicated that delayed-release DMF increased QALYs +0.450 or +0.359 compared with glatiramer acetate or fingolimod, respectively. Reductions in 20-year costs with delayed-release DMF were −$70,644 compared with once-daily glatiramer acetate and −$32,958 compared with fingolimod. In an analysis comparing delayed-release DMF to three-times-weekly glatiramer acetate and assuming similar efficacy and safety to the once-daily formulation, 20-year costs with delayed-release DMF were increased by $15,806 and cost per QALY gained was$35,142. The differences in costs were most sensitive to acquisition cost and inclusion of informal care costs and productivity losses. The differences in QALYs were most sensitive to the impact of delayed-release DMF on disease progression and the EDSS utility weights.</p> <p><b>Conclusion:</b></p> <p>Delayed-release DMF is likely to increase QALYs for patients with relapsing forms of MS and be cost-effective compared with fingolimod and glatiramer acetate.</p

Understanding Libertarian Morality: The Psychological Dispositions of Self-Identified Libertarians

<div><p>Libertarians are an increasingly prominent ideological group in U.S. politics, yet they have been largely unstudied. Across 16 measures in a large web-based sample that included 11,994 self-identified libertarians, we sought to understand the moral and psychological characteristics of self-described libertarians. Based on an intuitionist view of moral judgment, we focused on the underlying affective and cognitive dispositions that accompany this unique worldview. Compared to self-identified liberals and conservatives, libertarians showed 1) stronger endorsement of individual liberty as their foremost guiding principle, and weaker endorsement of all other moral principles; 2) a relatively cerebral as opposed to emotional cognitive style; and 3) lower interdependence and social relatedness. As predicted by intuitionist theories concerning the origins of moral reasoning, libertarian values showed convergent relationships with libertarian emotional dispositions and social preferences. Our findings add to a growing recognition of the role of personality differences in the organization of political attitudes.</p> </div

Libertarians exhibit a reason-based cognitive style according to a variety of measures.

<p>Libertarians exhibit a reason-based cognitive style according to a variety of measures.</p

Structural Equation Model showing relationship between libertarian dispositions and values.

<p>Structural Equation Model showing relationship between libertarian dispositions and values.</p

Libertarians are more concerned with liberty values and less concerned with other-oriented and conservative values.

<p>Libertarians are more concerned with liberty values and less concerned with other-oriented and conservative values.</p

Means and Cohen's d-scores for measures in Study 1.

<p> <i>Note:</i></p>*<p> <i>p<.01,</i></p>**<p> <i>p<.001 (two tailed).</i></p

Principle Components Analysis Factor Loadings of Variables in Study 3.

<p> <i>Note: Factor loadings <|.1| omitted. Factor loadings >|.5| bolded.</i></p

Libertarians are less connected to others, including both broad and tight social connections.

<p>Libertarians are less connected to others, including both broad and tight social connections.</p

Libertarians report lower emotional responsiveness, but higher levels of psychological reactance.

<p>Libertarians report lower emotional responsiveness, but higher levels of psychological reactance.</p

Means and Cohen's d-scores for scales in Study 3.

<p> <i>Note:</i></p>*<p> <i>p<.01,</i></p>**<p> <i>p<.001 (two tailed).</i></p