PND18 CLINICAL AND ECONOMIC IMPACT OF INITIATING DIMETHYL FUMARATE VERSUS OTHER DISEASE MODYFING THERAPIES IN PATIENTS WITH RELAPSING-REMITTING MULTIPLE SCLEROSIS IN GERMANY

Abstract

To evaluate the economic impact among relapsing-remitting multiple sclerosis (RRMS) patients in Germany initiating treatment with dimethyl fumarate (DMF) versus the initiation of DMF following treatment failure of glatiramer acetate (GA), teriflunomide (TER), or a mixed market combination of interferons (IFNs). A Markov model of 10 health states (EDSS scores from 0 to 9) and death over a lifetime horizon in MS patients using annual cycles was used to compare the outcomes of treated RRMS patients from a societal perspective. The model incorporates the ability to fail the initial DMT and subsequently switch to another DMT based on incurring ≥ 2 relapses within a 12-month period. Efficacy inputs were estimated from a mixed treatment comparison, including hazard ratios for 6-month confirmed disability progression, and risk ratios for annual relapse rates. Economic inputs included the costs of treatment, relapse, and disability status. All estimates are analyzed using the eligible cohort of DMF patients overall and per patient and reflect costs in 2018 Euros. The model results showed that among RRMS patients initially treated with DMF in Germany, average time on initial therapy was 11.1 years as compared to GA (6.7 years), TERI (5.6 years) and IFNs (6.8 years). Initiating treatment with DMF resulted in relapse offsets of 2.3 compared to GA, 2.2 compared to TERI, and 1.9 compared to IFNs. When initiating DMF as first-line therapy, the total costs per patient were reduced by €46,414 versus GA, €25,583 versus TERI, and €60,124 versus IFNs. The total cost savings for all DMF patients in Germany (n = 10,510) were ∼€1B versus GA, ∼€570M versus TERI, and ∼€1.3B versus IFNs. Initiating DMF as the initial treatment for German RRMS patients before initiating and failing on GA, TERI, or IFNs results improved economic benefits. Supported by: Biogen.