Cost-Effectiveness of Disease-Modifying Therapies for the Treatment of Patients with Highly Active Multiple Sclerosis - Swedish Perspective (P06.199)

Abstract

Objective: Determine cost-effectiveness of natalizumab versus fingolimod in patients with highly active relapsing-remitting multiple sclerosis (MS). Background Treatment alternatives for patients with highly active MS (rapidly evolving disease [RED] and suboptimal response [SOR] to prior therapy) have increased with introduction of fingolimod. Clinical efficacy/safety/economic data comparing fingolimod with natalizumab, both indicated for this population, will become increasingly important. Design/Methods: Economic model comparing fingolimod with natalizumab for patients with highly active relapsing-remitting MS from Swedish healthcare system perspective to estimate direct medical costs (2011 Swedish krona [kr]) over 2-year time horizon was developed. Costs were modeled in terms of drug acquisition costs, administration and monitoring costs, and treatment of MS relapses. Effectiveness was assessed in terms of MS relapses avoided using placebo-adjusted relapse rates from subgroup analyses of highly active patients in AFFIRM and SENTINEL trials for natalizumab and in European Medicines Agency Assessment Report for fingolimod. Standard errors were used to create distributions for model parameters, and probabilistic sensitivity analysis was conducted. Results: Estimated treatment cost with natalizumab was 445,628kr and 457,406kr in RED and SOR groups, respectively, compared with 445,535kr and 453,752kr with fingolimod for same groups. Patients receiving natalizumab had a mean of 2.40 and 2.02 relapses avoided per 2 years in RED and SOR groups, whereas they were 1.87 and 1.60 with fingolimod for same groups, respectively. Costs associated with each relapse avoided with natalizumab were 46% of cases in both groups where fingolimod was dominant in Conclusions: From Swedish healthcare system perspective, natalizumab is a cost-effective treatment compared with fingolimod for patients with highly active MS. Supported by: Biogen Idec Inc. Disclosure: Dr. O9Day has received personal compensation for activities with Xcenda as a consultant. Dr. Deniz has received personal compensation for activities with Biogen Idec Inc. as an employee.Dr. Deniz holds stock and/or stock options in Vertex Pharmaceuticals. Dr. Meyer has received personal compensation for activities with Xcenda as an employee.