Article,
Comparative effectiveness and cost-effectiveness of natalizumab and fingolimod in rapidly evolving severe relapsing-remitting multiple sclerosis in the United Kingdom
Contributors
Spelman T.
0000-0001-9204-3216
[1]
[2]
Herring W.L.
0000-0001-8222-9914
[2]
[3]
Acosta C.
0000-0002-7257-8675
Jokubaitis V.
0000-0002-3942-4340
[4]
Lugaresi A.
0000-0003-2902-5589
[5]
[6]
Horakova D.
0000-0003-1915-0036
[8]
Eichau S.
0000-0001-9159-3128
[9]
Alroughani R.
0000-0001-5436-5804
[11]
Kalincik T.
0000-0003-3778-1376
[12]
[13]
Girard M.
0000-0001-8207-8896
[14]
Petersen T.
0000-0001-5633-2600
[15]
Patti F.
0000-0002-6923-0846
[16]
Csepany T.
0000-0002-8305-3209
[17]
Ferraro D.
0000-0003-4818-3806
[20]
Van Pesch V.
0000-0003-2885-9004
McCombe P.
0000-0003-2704-8517
[26]
Rozsa C.
0000-0001-9415-6177
[29]
Hodgkinson S.
0000-0002-9029-6663
[30]
Gouider R.
0000-0001-9615-3797
[32]
Prevost J.
0000-0002-8440-8577
[35]
Sanchez-Menoyo J.L.
0000-0003-2634-8294
[39]
[40]
van der Walt A.
0000-0002-4278-7003
[4]
[43]
Terzi M.
0000-0002-3586-9115
[50]
Solaro C.
0000-0002-6713-4623
Fragoso Y.
0000-0001-8726-089X
[54]
Shaygannejad V.
0000-0002-9732-4153
[55]
Rajda C.
0000-0002-0252-4778
[57]
Butzkueven H.
0000-0003-3940-8727
[4]
Affiliations
- [1] MS Base Foundation
- [2] Karolinska Institutet [NORA names: Sweden; Europe, EU; Nordic; OECD];
- [3] RTI Health Solutions [NORA names: United States; America, North; OECD];
- [4] Monash University [NORA names: Australia; Oceania; OECD];
- [5] IRCCS Istituto delle Scienze Neurologiche di Bologna [NORA names: Italy; Europe, EU; OECD];
(... more)
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.
