Cannabis-based medicines may be cost-effective for MS spasticity, but evidence is uncertain and industry-influenced | Research

The takeaway

A systematic review of 10 economic studies found that nabiximols (Sativex) was potentially cost-effective for MS spasticity from a European health system perspective, though results were uncertain and largely based on industry-sponsored analyses.

Read this if you are interested in the economic value of prescribed cannabis medicines or are involved in healthcare coverage decisions.

Only 10 economic studies found for all cannabis medicines; all for MS only

What the researchers found

Researchers systematically reviewed the economic costs and benefits of prescribed cannabis-based medicines across all chronic illnesses.

Of 2,514 records identified, only 10 studies met criteria, all focused on multiple sclerosis (MS). No economic evaluations existed for any other condition.

Four of five industry-sponsored cost-utility analyses found nabiximols cost-effective for MS spasticity. Cost per quality-adjusted life-year (QALY) ranged from dominant (saving money) in Spain to £49,257 in the UK. However, nabiximols was not associated with statistically significant improvements in EQ-5D quality of life scores compared to standard care.

The disconnect between cost-effectiveness claims and lack of significant quality of life improvement raises questions about the robustness of these economic analyses.

Study quality was moderate overall, with limited inclusion of societal costs and limited discussion of potential bias.

Why it matters

As cannabis-based medicines are considered for insurance coverage and health system formularies, economic evidence is critical. The finding that most existing evidence is industry-sponsored and limited to one condition (MS) highlights the need for independent economic evaluations across the many conditions where cannabinoids are used.

The numbers in context

2,514 records screened, 10 met criteria. All 10 for MS. Cost per QALY: £49,257 (UK), £10,891 (Wales), €11,214 (Germany), €4,968 (Italy), dominant (Spain). 4 of 5 industry-sponsored analyses found nabiximols cost-effective. EQ-5D improvements not statistically significant.

How the study worked

Systematic review of eight medical and economic databases from inception to December 2016. MeSH headings and text words combined for economic evaluations and cannabis-based medicines. Quality assessed with relevant checklists. PROSPERO registered (CRD42014006370).

What this study cannot tell us

All studies were for MS only, limiting applicability to other conditions. Most were industry-sponsored, introducing potential bias. The non-significant quality of life improvements raise questions about cost-effectiveness models. Only European health system perspectives were represented. Study quality was moderate.

How to read the evidence

Systematic review with registered protocol provides moderate evidence, limited by the small number of included studies and predominance of industry funding.

When this study was published

Published in 2018 with literature through December 2016. Additional economic analyses may have been published since.

The bigger picture

The absence of economic evaluations for cannabinoid use in any condition beyond MS is striking, given the dozens of conditions for which cannabinoids are prescribed or self-administered. This gap makes it impossible to make evidence-based coverage and reimbursement decisions for most cannabinoid prescribing.

Questions still open

Would independent (non-industry) economic evaluations reach the same conclusions? Why have no economic evaluations been conducted for cannabinoid use in pain, epilepsy, or other conditions? How should the cost of legal vs. black market cannabis be factored into economic analyses?

Common questions

Are cannabis medicines cost-effective?

For MS spasticity, industry-sponsored analyses suggest nabiximols (Sativex) may be cost-effective in European health systems. However, quality of life improvements were not statistically significant, and no economic evaluations exist for any other condition.

Why are there so few economic studies?

The field is relatively new, and economic evaluations are expensive. The fact that all 10 studies focused on MS, the condition with the most established cannabinoid medications, reflects the maturity of that specific evidence base compared to other conditions.

Read the original research

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

PharmacoEconomics, 36(1), 67-78

View on PubMed ↗Publisher’s paper ↗

Citation

Herzog, Samuel; Shanahan, Marian; Grimison, Peter; Tran, Anh; Wong, Nicole; Lintzeris, Nicholas; Simes, John; Stockler, Martin; Morton, Rachael L. (2018). Systematic Review of the Costs and Benefits of Prescribed Cannabis-Based Medicines for the Management of Chronic Illness: Lessons from Multiple Sclerosis.. PharmacoEconomics, 36(1), 67-78. https://doi.org/10.1007/s40273-017-0565-6