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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

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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