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Comparative Effectiveness and Cost-Effectiveness of Natalizumab and Fingolimod in Rapidly Evolving Severe Relapsing-Remitting Multiple Sclerosis in the United Kingdom Publisher Pubmed



Spelman T1, 2 ; Herring WL3, 4 ; Acosta C5 ; Hyde R6 ; Jokubaitis VG7 ; Pucci E8 ; Lugaresi A9, 10 ; Laureys G11 ; Havrdova EK12 ; Horakova D12 ; Izquierdo G13 ; Eichau S13 ; Ozakbas S14 ; Alroughani R15 Show All Authors
Authors
  1. Spelman T1, 2
  2. Herring WL3, 4
  3. Acosta C5
  4. Hyde R6
  5. Jokubaitis VG7
  6. Pucci E8
  7. Lugaresi A9, 10
  8. Laureys G11
  9. Havrdova EK12
  10. Horakova D12
  11. Izquierdo G13
  12. Eichau S13
  13. Ozakbas S14
  14. Alroughani R15
  15. Kalincik T16, 17
  16. Duquette P18
  17. Girard M18
  18. Petersen T19
  19. Patti F20, 21
  20. Csepany T22
  21. Granella F23, 24
  22. Grandmaison F25
  23. Ferraro D26
  24. Karabudak R27
  25. Jose Sa M28, 29
  26. Trojano M30
  27. Van Pesch V31, 32
  28. Van Wijmeersch B33
  29. Cartechini E34
  30. Mccombe P35, 36
  31. Gerlach O37, 38
  32. Spitaleri D39
  33. Rozsa C40
  34. Hodgkinson S41
  35. Bergamaschi R42
  36. Gouider R43, 44
  37. Soysal A45
  38. Prevost J47
  39. Garber J48
  40. De Gans K49
  41. Ampapa R50
  42. Simo M51
  43. Sanchezmenoyo JL52, 53
  44. Iuliano G54
  45. Sas A55
  46. Van Der Walt A7, 56
  47. John N57, 58
  48. Gray O59
  49. Hughes S60
  50. De Luca G61
  51. Onofrj M62
  52. Buzzard K63, 64, 65
  53. Skibina O56, 64, 66
  54. Terzi M67
  55. Slee M68
  56. Solaro C69, 70
  57. Ramotello C72
  58. Fragoso Y73
  59. Shaygannejad V74
  60. Moore F75
  61. Rajda C76
  62. Aguera Morales E77, 78
  63. Butzkueven H7
Show Affiliations
Authors Affiliations
  1. 1. MSBase Foundation, Melbourne, VIC, Australia
  2. 2. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
  3. 3. Health Economics, RTI Health Solutions, NC, United States
  4. 4. Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
  5. 5. Value and Access, Biogen, Baar, Switzerland
  6. 6. Medical, Biogen, Baar, Switzerland
  7. 7. Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
  8. 8. Neurology Unit, AST-Fermo, Fermo, Italy
  9. 9. Dipartamento di Scienze Biomediche e Neuromotorie, Universita di Bologna, Bologna, Italy
  10. 10. IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
  11. 11. Department of Neurology, University Hospital Ghent, Ghent, Belgium
  12. 12. Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
  13. 13. Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
  14. 14. Izmir University of Economics, Medical Point Hospital, Izmir, Turkiye
  15. 15. Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
  16. 16. Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
  17. 17. CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
  18. 18. CHUM and Universite de Montreal, Montreal, Canada
  19. 19. Aarhus University Hospital, Arhus C, Denmark
  20. 20. Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy
  21. 21. UOS Sclerosi Multipla, AOU Policlinico “G Rodloico-San Marco”, University of Catania, Italy
  22. 22. Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
  23. 23. Department of Medicine and Surgery, University of Parma, Parma, Italy
  24. 24. Department of General Medicine, Parma University Hospital, Parma, Italy
  25. 25. Neuro Rive-Sud, QC, Canada
  26. 26. Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
  27. 27. Hacettepe University, Ankara, Turkiye
  28. 28. Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
  29. 29. Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
  30. 30. School of Medicine, University of Bari, Bari, Italy
  31. 31. Cliniques Universitaires Saint-Luc, Brussels, Belgium
  32. 32. Universite Catholique de Louvain, Belgium
  33. 33. University MS Centre, Hasselt-Pelt and Noorderhart Rehabilitation & MS, Pelt and Hasselt University, Hasselt, Belgium
  34. 34. Neurology unit, AST Macerata, Macerata, Italy
  35. 35. University of Queensland, Brisbane, Australia
  36. 36. Royal Brisbane and Women’s Hospital, Herston, Australia
  37. 37. Academic MS Center Zuyd, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, Netherlands
  38. 38. School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
  39. 39. Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
  40. 40. Jahn Ferenc Teaching Hospital, Budapest, Hungary
  41. 41. Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, Australia
  42. 42. IRCCS Mondino Foundation, Pavia, Italy
  43. 43. Department of Neurology, LR18SP03 and Clinical Investigation Center Neurosciences and Mental Health, Razi University Hospital –, Tunis, Mannouba, Tunisia
  44. 44. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
  45. 45. Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkiye
  46. 46. Hospital Universitario Donostia and IIS Biodonostia, San Sebastian, Spain
  47. 47. CSSS Saint-Jerome, Saint-Jerome, Canada
  48. 48. Westmead Hospital, Sydney, Australia
  49. 49. Groene Hart Ziekenhuis, Gouda, Netherlands
  50. 50. Nemocnice Jihlava, Jihlava, Czech Republic
  51. 51. Department of Neurology, Semmelweis University Budapest, Budapest, Hungary
  52. 52. Department of Neurology, Galdakao-Usansolo University Hospital, Osakidetza Basque Health Service, Galdakao, Spain
  53. 53. Biocruces-Bizkaia Health Research Institute, Spain
  54. 54. Ospedali Riuniti di Salerno, Salerno, Italy
  55. 55. Department of Neurology and Stroke, BAZ County Hospital, Miskolc, Hungary
  56. 56. Department of Neurology, The Alfred Hospital, Melbourne, Australia
  57. 57. Monash University, Clayton, Australia
  58. 58. Department of Neurology, Monash Health, Clayton, Australia
  59. 59. South Eastern HSC Trust, Belfast, United Kingdom
  60. 60. Royal Victoria Hospital, Belfast, United Kingdom
  61. 61. MS Centre, Neurology Unit, “SS. Annunziata” University Hospital, University “G. d’Annunzio”, Chieti, Italy
  62. 62. Department of Neuroscience, Imaging, and Clinical Sciences, University G. d’Annunzio, Chieti, Italy
  63. 63. Department of Neurosciences, Box Hill Hospital, Melbourne, Australia
  64. 64. Monash University, Melbourne, Australia
  65. 65. MS Centre, Royal Melbourne Hospital, Melbourne, Australia
  66. 66. Department of Neurology, Box Hill Hospital, Melbourne, Australia
  67. 67. Medical Faculty, 19 Mayis University, Samsun, Turkiye
  68. 68. Flinders University, Adelaide, Australia
  69. 69. Department of Neurology, ASL3 Genovese, Genova, Italy
  70. 70. Department of Rehabilitation, ML Novarese Hospital Moncrivello, Italy
  71. 71. Department of Neurology, Hospital Clinico San Carlos, Madrid, Spain
  72. 72. Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain
  73. 73. Universidade Metropolitana de Santos, Santos, Brazil
  74. 74. Isfahan University of Medical Sciences, Isfahan, Iran
  75. 75. Department of Neurology, McGill University, Montreal, Canada
  76. 76. Department of Neurology, University of Szeged, Szeged, Hungary
  77. 77. Department of Medicine and Surgery, University of Cordoba, Cordoba, Spain
  78. 78. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Spain

Source: Journal of Medical Economics Published:2024


Abstract

Aim: 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). Methods: 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. Results: 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. Conclusions: 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. © 2023 Biogen. Published by Informa UK Limited, trading as Taylor & Francis Group.
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