Cannabis-based medicines may be cost-effective for MS spasticity, but evidence is uncertain and industry-influenced
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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).
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- Only 10 economic studies found for all cannabis medicines; all for MS only
- Evidence Grade:
- Systematic review with registered protocol provides moderate evidence, limited by the small number of included studies and predominance of industry funding.
- Study Age:
- Published in 2018 with literature through December 2016. Additional economic analyses may have been published since.
- Original Title:
- Systematic Review of the Costs and Benefits of Prescribed Cannabis-Based Medicines for the Management of Chronic Illness: Lessons from Multiple Sclerosis.
- Published In:
- PharmacoEconomics, 36(1), 67-78 (2018)
- Authors:
- Herzog, Samuel, Shanahan, Marian(3), Grimison, Peter(2), Tran, Anh, Wong, Nicole, Lintzeris, Nicholas, Simes, John, Stockler, Martin, Morton, Rachael L
- Database ID:
- RTHC-01689
Evidence Hierarchy
Analyzes all available research on a topic using a structured method.
What do these levels mean? →Frequently Asked 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.
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Cite This Study
https://rethinkthc.com/research/RTHC-01689APA
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
MLA
Herzog, Samuel, et al. "Systematic Review of the Costs and Benefits of Prescribed Cannabis-Based Medicines for the Management of Chronic Illness: Lessons from Multiple Sclerosis.." PharmacoEconomics, 2018. https://doi.org/10.1007/s40273-017-0565-6
RethinkTHC
RethinkTHC Research Database. "Systematic Review of the Costs and Benefits of Prescribed Ca..." RTHC-01689. Retrieved from https://rethinkthc.com/research/herzog-2018-systematic-review-of-the
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.