Evolution of the Healthcare Expenditure in Italy and Effects of Fingolimod Increased Prescribing in Second Line Treatment of Relapsing-Remitting Multiple Sclerosis

Abstract

Purpose To analyse the evolution of impact on the healthcare expenditure of first and second line treatments for relapsing-remitting multiple sclerosis (RRMS) in Italy. Methods An economic model was developed in MSTM Excel (2010) and populated with data from three of the main Regions (Lombardy, Lazio, and Sicily) considered representative in Italy for location (North, Centre and South, respectively), population, and care organisation. Input data were retrieved from published sources and validated by a Board* of experts. The analysis considers an average from regional healthcare resource consumption, and national tariffs were used to economically quantify it. A sensitivity analysis was performed varying the market shares of second line treatments (fingolimod and natalizumab). * I nomi dei membri del Board sono riportati a fine articolo Results The results show that the total drug expenditure is €542,279,468 for both first and second line treatments. Among second line treatments, fingolimod showed to be less expensive than natalizumab with an annual mean saving per patient of €4,276 (of which €2,120 for routine management). The sensitivity analysis shows that, increasing the market shares of fingolimod from 59% of the base case to 80%, it is possible to achieve savings for almost €8.5 million/year. Conclusions Fingolimod is an affordable therapy for the Italian National Health Service. Moreover, due to a timely use of fingolimod in patients not responding to first line drugs, savings could be around €10 million due to avoided relapses.