Medical cannabis may be cost-effective for MS spasticity and Dravet syndrome, but evidence is limited | Research

The takeaway

A systematic review of 12 economic evaluations found that nabiximols appears cost-effective for MS spasticity in Europe and CBD for Dravet syndrome in Canada, though cost-effectiveness varied widely depending on setting and indication.

Health economists, formulary decision makers, medical cannabis policy makers

Cost-effectiveness ratios ranged from cost-saving to >$451,800 per QALY

What the researchers found

Twelve cost-utility analyses were identified across MS (n=8), pediatric epilepsies (n=2), and chronic pain (n=2). Incremental cost-effectiveness ratios ranged from cost-saving to over $451,800 per quality-adjusted life-year. Nabiximols was consistently cost-effective for MS spasticity in European settings. CBD was cost-effective for Dravet syndrome in Canada but not for Lennox-Gastaut syndrome in the US.

Why it matters

As medicinal cannabis is often expensive compared to illicit supply, understanding its cost-effectiveness is essential for healthcare systems making coverage and formulary decisions.

The numbers in context

12 cost-utility analyses; 8 for MS, 2 for epilepsy, 2 for chronic pain; cost-effectiveness ratios ranged from cost-saving to >$451,800/QALY; median CHEERS quality 83% (range 70-100%)

How the study worked

Systematic search of seven databases for economic evaluations of medicinal cannabis published through September 2020. Quality assessed using the CHEERS checklist. Data grouped by medical condition and reported narratively.

What this study cannot tell us

Only 12 studies identified, reflecting the nascent state of cannabis health economics. Most studies focused on MS. Limited geographic diversity. Economic models depend on clinical trial data that may not reflect real-world effectiveness.

How to read the evidence

Systematic review with good-quality included studies, but the small number and limited scope of conditions reviewed constrain the conclusions.

When this study was published

Published in 2021 reviewing studies through September 2020.

The bigger picture

The wide range of cost-effectiveness ratios highlights that medicinal cannabis value depends heavily on the specific product, indication, and healthcare system. Blanket statements about cost-effectiveness are not supported.

Questions still open

Would cost-effectiveness improve as medicinal cannabis production scales and prices decrease? Are there conditions beyond MS and epilepsy where cannabis-based medicines would be cost-effective?

Common questions

Is medical cannabis a good value for healthcare systems?

It depends. Nabiximols for MS spasticity appears cost-effective in multiple European settings. CBD for Dravet syndrome was cost-effective in Canada. But for other conditions and settings, the evidence is too limited to draw conclusions.

Why is the cost range so wide?

Different products (nabiximols, CBD, other formulations), different conditions, different healthcare systems, and different comparison treatments all affect cost-effectiveness calculations. There is no single answer for all of medical cannabis.

Read the original research

Cost-Effectiveness of Medicinal Cannabis for Management of Refractory Symptoms Associated With Chronic Conditions: A Systematic Review of Economic Evaluations.

Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 24(10), 1520-1530

View on PubMed ↗Publisher’s paper ↗

Citation

Erku, Daniel; Shrestha, Shakti; Scuffham, Paul. (2021). Cost-Effectiveness of Medicinal Cannabis for Management of Refractory Symptoms Associated With Chronic Conditions: A Systematic Review of Economic Evaluations.. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 24(10), 1520-1530. https://doi.org/10.1016/j.jval.2021.04.1276