Abstract
IntroductionMultiple sclerosis (MS) is an inflammatory disease in which the myelin sheaths of the nerve cells in the brain and spinal cord, which are responsible for communication, are destroyed and cause physical signs and symptoms. According to studies, anti-CD20 monoclonal antibodies have significant results in the treatment of this disease. Thus, the aim of the present study was to determine the cost-effectiveness of rituximab against natalizumab in the patients with RRMS in southern Iran in 2020.MethodsThis is an economic evaluation including cost-effectiveness analysis in which the Markov model with a lifetime horizon was used. The study sample consisted of 120 patients randomly selected from among those referred to the MS Association and the Special Diseases Unit of Shiraz University of Medical Sciences. In this study, the costs were collected from a societal perspective, and the outcomes were obtained in the form of Quality Adjusted Life Years (QALY) and the mean relapse rate. The TreeAge pro 2020 and Excel 2016 software were used for data analysis.ResultsThe comparative study of rituximab and natalizumab showed that the patients receiving rituximab had lower costs ($ 58,307.93 vs. $ 354,174.85) and more QALYs (7.77 vs. 7.65). In addition, the incidence of relapse by rituximab was lower compared to natalizumab (1.15 vs. 2.57). The probabilistic one-way sensitivity analysis showed the robustness of the results. The scatter plots also showed that rituximab was more cost-effective for the patients in 100% of the simulations for the threshold of < $ 37,641.Discussion and conclusionAccording to the results of this study, rituximab had higher cost-effectiveness than natalizumab. Therefore, it could be a priority for RRMS patients compared to natalizumab because it reduced treatment costs and increased effectiveness.
Highlights
Multiple sclerosis (MS) is an inflammatory disease in which the myelin sheaths of the nerve cells in the brain and spinal cord, which are responsible for communication, are destroyed and cause physical signs and symptoms
Overview and model structure This is a full economic evaluation of cost-effectiveness analysis type conducted on the patients using natalizumab (300 mg 1 injection per months) and rituximab (1000 mg 1 injection per 6 months) who referred to the MS Association and the Special Diseases Unit of Shiraz University of Medical Sciences in 2020
As long as the patients are not transferred to a higher level than Expanded Disability Status Scale (EDSS) 3–5.5, they remain in relapsing remitting multiple sclerosis (RRMS) status, and when transited to the EDSS 6–7.5 level or higher, they are considered as Secondary Progressive Multiple Sclerosis (SPMS) and their Disease-modifying therapies (DMT) are stopped [35]
Summary
Multiple sclerosis (MS) is an inflammatory disease in which the myelin sheaths of the nerve cells in the brain and spinal cord, which are responsible for communication, are destroyed and cause physical signs and symptoms. Multiple sclerosis (MS) is an inflammatory disease in which the myelin sheaths of the nerve cells in the brain and spinal cord are damaged. According to the studies carried out from 2011 to 2020 in different provinces, the prevalence of the disease in Iran ranged from 27.7 per 100,000 in East Azerbaijan to 148.06 per 100,000 in Tehran [6,7,8,9,10,11,12]. MS has a significant negative effect on patients’ quality of life [14]. The increased disability had a significant effect on healthrelated quality of life and the fatigue in daily life [16]
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