POSB77 Comparing the Total Costs of Oral Disease Modifying Therapies for Patients with Active Relapsing Multiple Sclerosis in the US

Abstract

There are currently several effective oral disease modifying therapies (DMTs) available for the treatment of active relapsing multiple sclerosis (RMS). This analysis aims to compare the lifetime costs of oral DMTs from a US societal perspective. This economic perspective may aid in decision making for patients for whom an oral therapy is the most appropriate or preferred option. A Markov model was constructed including 5 oral disease-modifying therapies. Health states were defined by Expanded Disability Status Scale (EDSS) scores with transitions allowed to secondary progressive MS (SPMS). Patients were assumed to transition to best supportive care after discontinuation of the first-line treatment. Direct costs related to treatment acquisition, administration, and monitoring, adverse events (AEs), disease management, and relapses as well as indirect disease costs (productivity loss, changes in working situation, and early retirement) were included. Data was sourced from published literature, cost databases, and a network meta-analysis. Treatment was assumed to impact the rate of progression to higher EDSS states (both RMS and SPMS) and the rate of relapses. All costs (2021 USD) were discounted at 3% annually. Total lifetime costs ranged from $1,728,582 (ponesimod) to $2,002,709 (fingolimod). First-line treatment costs (acquisition, administration, monitoring, and AEs) comprised between 28.7% of total costs ($495,627, ponesimod) and 38.2% ($764,173, fingolimod). Direct and indirect costs for disease management were also lowest for ponesimod ($379,847 and $853,107, respectively). Teriflunomide was estimated to have the highest disease management costs (direct and indirect: $385,611 and $862,425, respectively). For all comparators, indirect costs accounted for approximately 42 to 49% of the total cost of treatment. Among the currently available oral DMTs for RMS, ponesimod is likely to result in the lowest lifetime costs from both a societal and healthcare sector perspective.