PND71 - A COST MINIMISATION ANALYSIS OF CLADRIBINE TABLETS VERSUS ALTERNATIVE HIGH EFFICACY TREATMENTS FOR RELAPSING MULTIPLE SCLEROSIS (RMS) IN THE UNIED KINGDOM.

Abstract

In 2017, Cladribine Tablets (MAVENCLAD®) received its marketing authorization from the European Medicines Agency (EMA) for the treatment of patients with highly active relapsing multiple sclerosis (HA-RMS). In a Network Meta-Analysis (NMA) conducted by Siddiqui et al in 2017, the credible intervals for Cladribine Tablets, compared to alemtuzumab, fingolimod, and natalizumab, overlapped for key efficacy endpoints. Due to no statistical differences demonstrated in the NMA, the aim of this analysis was to assume comparable efficacy among these Disease Modifying Treatments (DMTs) and conduct a Cost Minimization Analysis (CMA) of Cladribine Tablets against these alternatives in a National Health Service (NHS) United Kingdom (U.K) setting. An economic model, based on a UK perspective, published by Hettle et al (2018) was adapted to assume hazard ratios (HRs) of 1 for Confirmed Disability Progression (CDP) and Annualized Relapse Rate (ARR), versus the comparators: alemtuzumab, fingolimod, and natalizumab. A discount rate of 3.5% was used for both costs and benefits. Costs were obtained from the 2016/17 NHS reference tariffs and from the British National Formulary (BNF). Discontinuation rates for each treatment were set to 0%. The time horizon was 50 years. Safety profiles of the DMTs, based on clinical studies were included. Health state utilities were also incorporated. In this analysis, Cladribine Tables versus alemtuzumab, fingolimod and natalizumab resulted in minor incremental QALY difference of 0.007, -0.004 and -0.003 respectively. The corresponding incremental savings are; £-8,453, £-199,635 and £-234,430. In this CMA modelling approach, the QALY differences between the products are minor and mainly due to differences in Adverse Events (AEs) disutilities. Cladribine Tablets demonstrated clear incremental savings versus the alternatives,particularly when compared to continuous treatment products such as fingolimod and natalizumab.