Comparative effectiveness and cost-effectiveness of natalizumab and fingolimod in rapidly evolving severe relapsing-remitting multiple sclerosis in the United Kingdom.
Journal: Journal of medical economics
Volume: 27
Issue: 1
Year of Publication: 2023
Affiliated Institutions:
MSBase Foundation, Melbourne, VIC, Australia.
Health Economics, RTI Health Solutions, NC, USA.
Value and Access, Biogen, Baar, Switzerland.
Medical, Biogen, Baar, Switzerland.
Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.
Neurology Unit, AST-Fermo, Fermo, Italy.
Dipartamento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.
Department of Neurology, University Hospital Ghent, Ghent, Belgium.
Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.
Izmir University of Economics, Medical Point Hospital, Izmir, Turkey.
Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait.
Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia.
CHUM and Universite de Montreal, Montreal, Canada.
Aarhus University Hospital, Arhus C, Denmark.
Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy.
Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Department of Medicine and Surgery, University of Parma, Parma, Italy.
Neuro Rive-Sud, Quebec, Canada.
Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy.
Hacettepe University, Ankara, Turkey.
Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal.
School of Medicine, University of Bari, Bari, Italy.
Cliniques Universitaires Saint-Luc, Brussels, Belgium.
University MS Centre, Hasselt-Pelt and Noorderhart Rehabilitation & MS, Pelt and Hasselt University, Hasselt, Belgium.
Neurology unit, AST Macerata, Macerata, Italy.
University of Queensland, Brisbane, Australia.
Academic MS Center Zuyd, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands.
Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy.
Jahn Ferenc Teaching Hospital, Budapest, Hungary.
Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, Australia.
IRCCS Mondino Foundation, Pavia, Italy.
Department of Neurology, LRSP and Clinical Investigation Center Neurosciences and Mental Health, Razi University Hospital -, Mannouba, Tunis, Tunisia.
Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey.
Hospital Universitario Donostia and IIS Biodonostia, San Sebastián, Spain.
CSSS Saint-Jérôme, Saint-Jerome, Canada.
Westmead Hospital, Sydney, Australia.
Groene Hart Ziekenhuis, Gouda, Netherlands.
Nemocnice Jihlava, Jihlava, Czech Republic.
Department of Neurology, Semmelweis University Budapest, Budapest, Hungary.
Department of Neurology, Galdakao-Usansolo University Hospital, Osakidetza Basque Health Service, Galdakao, Spain.
Ospedali Riuniti di Salerno, Salerno, Italy.
Department of Neurology and Stroke, BAZ County Hospital, Miskolc, Hungary.
Monash University, Clayton, Australia.
South Eastern HSC Trust, Belfast, United Kingdom.
Royal Victoria Hospital, Belfast, United Kingdom.
MS Centre, Neurology Unit, "SS. Annunziata" University Hospital, University "G. d'Annunzio", Chieti, Italy.
Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy.
Department of Neurosciences, Box Hill Hospital, Melbourne, Australia.
Department of Neurology, The Alfred Hospital, Melbourne, Australia.
Medical Faculty, Mayis University, Samsun, Turkey.
Flinders University, Adelaide, Australia.
Department of Neurology, ASL Genovese, Genova, Italy.
Department of Neurology, Hospital Clinico San Carlos, Madrid, Spain.
Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain.
Universidade Metropolitana de Santos, Santos, Brazil.
Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Neurology, McGill University, Montreal, Canada.
Department of Neurology, University of Szeged, Szeged, Hungary.
Department of Medicine and Surgery, University of Cordoba, Cordoba, Spain.
Abstract summary
To evaluate the real-world comparative effectiveness and the cost-effectiveness, from a UK National Health Service perspective, of natalizumab versus fingolimod in patients with rapidly evolving severe relapsing-remitting multiple sclerosis (RES-RRMS).Real-world data from the MSBase Registry were obtained for patients with RES-RRMS who were previously either naive to disease-modifying therapies or had been treated with interferon-based therapies, glatiramer acetate, dimethyl fumarate, or teriflunomide (collectively known as BRACETD). Matched cohorts were selected by 3-way multinomial propensity score matching, and the annualized relapse rate (ARR) and 6-month-confirmed disability worsening (CDW6M) and improvement (CDI6M) were compared between treatment groups. Comparative effectiveness results were used in a cost-effectiveness model comparing natalizumab and fingolimod, using an established Markov structure over a lifetime horizon with health states based on the Expanded Disability Status Scale. Additional model data sources included the UK MS Survey 2015, published literature, and publicly available sources.In the comparative effectiveness analysis, we found a significantly lower ARR for patients starting natalizumab compared with fingolimod (rate ratio [RR] = 0.65; 95% confidence interval [CI], 0.57-0.73) or BRACETD (RR = 0.46; 95% CI, 0.42-0.53). Similarly, CDI6M was higher for patients starting natalizumab compared with fingolimod (hazard ratio [HR] = 1.25; 95% CI, 1.01-1.55) and BRACETD (HR = 1.46; 95% CI, 1.16-1.85). In patients starting fingolimod, we found a lower ARR (RR = 0.72; 95% CI, 0.65-0.80) compared with starting BRACETD, but no difference in CDI6M (HR = 1.17; 95% CI, 0.91-1.50). Differences in CDW6M were not found between the treatment groups. In the base-case cost-effectiveness analysis, natalizumab dominated fingolimod (0.302 higher quality-adjusted life-years [QALYs] and £17,141 lower predicted lifetime costs). Similar cost-effectiveness results were observed across sensitivity analyses.This MSBase Registry analysis suggests that natalizumab improves clinical outcomes when compared with fingolimod, which translates to higher QALYs and lower costs in UK patients with RES-RRMS.
Authors & Co-authors:
Spelman T T
Herring W L WL
Acosta C C
Hyde R R
Jokubaitis V G VG
Pucci E E
Lugaresi A A
Laureys G G
Havrdova E K EK
Horakova D D
Izquierdo G G
Eichau S S
Ozakbas S S
Alroughani R R
Kalincik T T
Duquette P P
Girard M M
Petersen T T
Patti F F
Csepany T T
Granella F F
Grand'Maison F F
Ferraro D D
Karabudak R R
Jose Sa M M
Trojano M M
van Pesch V V
Van Wijmeersch B B
Cartechini E E
McCombe P P
Gerlach O O
Spitaleri D D
Rozsa C C
Hodgkinson S S
Bergamaschi R R
Gouider R R
Soysal A A
Castillo-Triviño
Prevost J J
Garber J J
de Gans K K
Ampapa R R
Simo M M
Sanchez-Menoyo J L JL
Iuliano G G
Sas A A
van der Walt A A
John N N
Gray O O
Hughes S S
De Luca G G
Onofrj M M
Buzzard K K
Skibina O O
Terzi M M
Slee M M
Solaro C C
Oreja-Guevara
Ramo-Tello C C
Fragoso Y Y
Shaygannejad V V
Moore F F
Rajda C C
Aguera Morales E E
Butzkueven H H
Study Outcome
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