Cost-utility analysis of Edaravone compared to Riluzole in patients with amyotrophic lateral sclerosis (ALS) in Iran

Amyotrophic lateral sclerosis (ALS) is a devastating disease that damages motor neurons. Currently, two drugs, Riluzole and Edaravone, have been shown to slow the progression of this condition. This study aimed to evaluate the cost-utility of Edaravone compared to Riluzole in ALS patients. This is an economic evaluation and cost-utility analysis from Iran’s health system perspective using a 10-year and 20-year Markov model. Cost data were collected from medical records and expert interviews, while clinical outcomes and transition probabilities were obtained from a clinical trial study. The robustness of the findings was tested through both deterministic and probabilistic sensitivity analysis. Data was analyzed using Excel 2019 and TreeAge Pro 2020 software. The findings of this study indicated that the cost of treatment and QALYs obtained from Edaravone (58,077 PPP$ and 1.66) compared to Riluzole (53,216 PPP$ and 1.37) were estimated to be higher in Iran. The calculated ICUR was equal to 16,704 PPP$ which is considered to be a cost-effective option in terms of the cost-effectiveness threshold to treat the patients with ALS. Furthermore, a one-way sensitivity analysis showed that the model is most affected by the cost discount rate and the price of Edaravone. Edaravone was identified as the best treatment strategy in 66% of simulations, making it the preferred option across different willingness to pay scenarios. The findings of the study indicated that the Edaravone may be a more cost-effective and affordable option compared to the Riluzole. Consequently, the availability of this drug in the country is likely to improve the quality of life and increase the survival rates of patients.