Cost-effectiveness of multidisciplinary care compared with standard neurology care in Amyotrophic Lateral Sclerosis: A model-based cost-utility analysis

Objective To evaluate the cost-effectiveness of multidisciplinary clinic (MDC) care compared with standard general neurology care for adults with amyotrophic lateral sclerosis (ALS). Methods A cost-utility analysis was conducted using a state-transition Markov model with monthly cycles over a 10-year horizon from the U.S. payer perspective. Health states comprised King's stages 1, 2, 3, 4 A, 4B, and death. Disease progression, mortality, utility, and cost inputs were derived from published literature (2005–2026). Transition probabilities were based on longitudinal data from the Pooled Resource Open-Access ALS Clinical Trials and permitted non-sequential progression. MDC-associated survival benefit was applied to stage-specific mortality across all King's stages. No additional utility benefit was assigned to MDC, while MDC-specific multipliers were applied to outpatient, inpatient, and emergency department costs. Outcomes included quality-adjusted life-years (QALYs), costs, cost per life-year gained, and incremental cost-effectiveness ratios (ICERs). Uncertainty intervals (UIs) were derived from sensitivity analyses. Results MDC increased costs ($523,170 vs $378,171) and QALYs (0.73 vs 0.60), yielding 0.13 incremental QALYs (95% UI, 0.06–0.20) at an incremental cost of US$144,999 (95% UI, $53,784–$257,504). The ICER was US$1,158,673/QALY and cost per life-year gained was US$149,483. MDC was cost-effective in 0.1% of simulations at a willingness-to-pay threshold of $150,000/QALY. Conclusion MDC improved survival and quality-adjusted survival but at substantially higher cost. Its ICER remained well above commonly used U.S. willingness-to-pay thresholds across sensitivity analyses, including alternative utility valuations. These findings highlight the distinction between clinical benefit and cost-effectiveness and quantify the long-term economic consequences of survival gains associated with multidisciplinary ALS care.