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Cost-Effectiveness of 6 Therapies for RRMS
San Diego—Multiple sclerosis (MS) is an unpredictable, often disabling disease with no known cure. Several disease-modifying treatments (DMTs) are FDA approved to reduce disease activity and progression. The safety and efficacy of DMTs for relapsing-remitting MS (RRMS), the most common subtype of the disease, have been demonstrated in clinical trials. It is not clear, however, which of the DMTs provides optimal value given their efficacy profiles and costs. In a new study, researchers estimated the cost-effectiveness of 6 DMTs from the perspective of a third-party payer in the United States. The results were presented at the AMCP meeting during a poster session titled The Cost-Effectiveness of Disease Modifying Therapies for the Treatment of Relapsing-Remitting Multiple Sclerosis.
A Markov state transition cohort model was created to predict the course of patients with RRMS following initiation of a DMT comparing natalizumab, dimethyl fumarate, and peginterferon beta-1a with fingolimod, glatiramer acetate, and interferon beta- 1a, respectively. A 10-year time horizon was evaluated for outcomes (ie, relapses, relapse-free years, disease progression, progression and clinical disease activity-free years) and costs (drug, administration, monitoring, relapse, and Expanded Disability Status Scale [EDSS] state costs). Transitions across RRMS EDSS states or the secondary-progressive MS (SPMS) EDSS states were predicted in 3-month cycles. While in any EDSS state, patients were at risk of death, relapse, or discontinuation in each treatment cycle. Upon DMT discontinuation, natural history progression and relapse rates were assumed to apply. Patients could discontinue following DMT-specific discontinuation rates, upon progression to SPMS, and reaching an EDSS level 7. Patients were assumed to be 38.1 years old, 72% female, with EDSS scores between 0 and 5 at the start of the model. Incremental cost- effectiveness ratios (ICERs) were estimated for the cost per relapse avoided, relapse-free years gained, progression avoided, and progression and clinical disease activity-free years gained. The impact of model parameters on outcomes was evaluated via 1-way sensitivity analyses. Cost and outcomes were discounted at 3% annually.
The model compared natalizumab 300 mg every 4 weeks versus fingolimod 0.5 mg once daily; dimethyl fumarate 240 mg twice daily versus glatiramer acetate 40 mg 3 times weekly; and peginterferon beta-1a 125 mcg every 2 weeks versus subcutaneous interferon beta-1a 44 mcg 3 times weekly.
The findings showed that natalizumab and dimethyl fumarate were less costly and more effective compared to fingolimod and glatiramer acetate, respectively, for all ICERs evaluated. The total economic outcomes discounted over 10 years were $485,773 for natalizumab compared with $497,074 for fingolimod and $477,158 for dimethyl fumarate compared with $479,590 for glatiramer acetate. Peginterferon beta- 1a was dominant (less costly, more effective) over interferon beta-1a in terms of progression outcomes and clinical disease activity outcomes. Comparable relapse-related outcomes were observed at an incremental cost of more than $30,000 with interferon beta-1a compared to peginterferon beta-1a.
The study’s authors noted some limitations. It was assumed that upon discontinuation, patients do not switch to a new treatment and that they would follow the natural history relapse and disease progression figures. Adverse events were not explicitly considered in the model. Cost of relapse was assumed to be the same, regardless of EDSS state or severity. The treatment effect of each drug was assumed to be constant over time, given the short 10-year time horizon.
“The results from this study suggest that natali- zumab, dimethyl fumarate, and peginterferon beta-1a are cost-effective DMT choices compared to fingo- limod, glatiramer acetate, and interferon beta-1a, respectively,” concluded the researchers. “The actual impact to a particular plan will vary based on drug pricing and other factors affecting drug cost accrual”.—Eileen Koutnik-Fotopoulos
This study was supported by Biogen Idec.
