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Aktuelle Neurologie 2008; 35(2): 70-80
DOI: 10.1055/s-2007-986247
Arzneimitteltherapie

© Georg Thieme Verlag KG Stuttgart · New York

Immunmodulierende Therapie bei multipler Sklerose: Health Technology Assessment und Leitlinien

Immunomodulating Therapy for Patients with Multiple Sclerosis: Health Technology Assessment and GuidelinesS.  Twork1 , K.  Voigt1 , M.  Menning2 , T.  Rotter1 , D.  Poehlau3 , J.  Kugler1
  • 1Medizinische Fakultät TU Dresden, Lehrstuhl Gesundheitswissenschaften/Public Health
  • 2Institut für Management im Gesundheitswesen
  • 3Kamillus Klinik Asbach, Neurologie
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Publication History

Publication Date:
13 November 2007 (online)

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Zusammenfassung

Die vorliegende Arbeit dient der Bestimmung des Stellenwerts der Therapie mit immunmodulierenden Medikamenten zur Behandlung der MS unter HTA-Gesichtspunkten und aktuellen Leitlinien aus Deutschland, Großbritannien und den USA. Bezüglich der MS-Therapie stellt sich die Frage, inwieweit die Therapien von der Wirksamkeit her als gleichwertig zu betrachten sind, wie die Kosten-Nutzwert-Relation ist und wie diese Erkenntnisse in den deutschen bzw. englischen und amerikanischen Leitlinien umgesetzt wurden. Die Therapie mit Interferon-beta und Glatiramerazetat ist als gleichwertig wirksam zu betrachten, was sich auch in den jeweiligen Leitlinien widerspiegelt. Demgegenüber stehen jedoch die hohen Therapiekosten, die das National Institute for Clinical Excellence dazu veranlassten, die Immunmodulatoren bei MS trotz Wirksamkeit nicht zu empfehlen. Dennoch wurde zugunsten der Patienten ein Kompromiss zwischen Patientenvertretern, Staat und Pharmaindustrie gefunden, um die Behandlung der MS zu gewährleisten. Dies zeigt den Stellenwert der evidenzbasierten Medizin, des Health Technology Assessments und der Leitlinienerstellung sowie die mögliche Flexibilität, um eine gute Versorgung der Patienten zu gewährleisten.

Abstract

This work highlights the significance of immunomodulating drugs in the therapy for multiple sclerosis (MS) under health technology assessment aspects and current German, British and American treatment guidelines. Concerning MS therapy the following aspects were analysed: if the efficacy of the various immunomodulating drugs is similar, which cost-benefit relations occur and how implementation in national guidelines was realised. The different therapeutic options, either with beta-interferons or glatirameracetate, show nearly the same effects, an aspect which is also reflected by the national guidelines (Germany, United Kingdom and USA). The costs for the MS therapy are high, which caused the National Institute for Clinical Excellence not to recommend this therapy despite its efficacy. However, a compromise was found to satisfy the needs of patients, the government and the pharmaceutical industry in order to realise treatment of the disease. This shows the importance of evidence-based medicine, health technology assessment and guidelines as well as a possible and necessary flexibility to achieve a good medical service to patients with MS.

Schlüsselwörter

Multiple Sklerose - Beta-Interferone - Glatiramerazetat - Leitlinien - Health Technology Assessment

Key words

multiple sclerosis - beta-interferons - glatiramer acetate - guidelines - health technology assessment

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Dr. Sabine Twork

Lehrstuhl Gesundheitswissenschaften/Public Health, TU Dresden, Medizinische Fakultät

Fiedlerstraße 33

01307 Dresden

Email: sabine_twork@hotmail.com