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Cost-effectiveness of early initiation of fingolimod versus delayed initiation after 1 year of intramuscular interferon beta-1a in patients with multiple sclerosis.
Clin Ther. 2012 Jul; 34(7):1583-90.CT

Abstract

BACKGROUND

Fingolimod is a once-daily orally administered disease-modifying therapy (DMT) indicated for treatment of relapsing forms of multiple sclerosis (MS) to reduce the frequency of clinical relapses and delay accumulation of physical disability. In the randomized, double-blind, phase 3 TRANSFORMS trial, 0.5 mg/d oral fingolimod substantially reduced relapse frequency when compared with IM interferon-β1a (IFN-β1a) at 12-months. In a 12-month, double-blind, extension phase of the TRANSFORMS study, patients assigned to receive fingolimod continued to receive the same dosage, whereas patients who originally received IM IFN-β1a were randomized to receive either 0.5 or 1.25 mg/d fingolimod.

OBJECTIVE

To investigate the cost-effectiveness of initiating fingolimod therapy early versus after 1 year of IFN-β1a therapy using TRANSFORMS study extension data.

METHODS

A Microsoft Excel-based model was used to calculate the cost per relapse avoided for 2 years with continuous treatment with fingolimod compared with first-year treatment with IM IFN-β1a and second-year treatment with fingolimod. One-way sensitivity analyses were conducted on key input variables to assess their effect on cost per relapse avoided.

RESULTS

The 2-year relapse rate in the early fingolimod arm was 0.23, and in the delayed fingolimod arm was 0.53. The cost per relapse avoided was $83,125 in the early fingolimod arm versus $103,624 in the delayed fingolimod arm. Results of the sensitivity analyses showed an effect of drug acquisition cost and number of relapses in patients who received no treatment.

CONCLUSION

Continuous treatment with fingolimod for 2 years resulted in a lower cost per relapse avoided compared with treatment with IM IFN-β1a for the first year and then switching to fingolimod therapy. Thus, delaying fingolimod therapy does not seem to be cost effective.

Authors+Show Affiliations

Novartis Pharmaceuticals Corporation, Health Economics & Outcomes Research, One HealthPlaza, East Hanover, NJ 07936-1080, USA. neetu.agashivala@novartis.comNo affiliation info available

Pub Type(s)

Clinical Trial, Phase III
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22749258

Citation

Agashivala, Neetu, and Edward Kim. "Cost-effectiveness of Early Initiation of Fingolimod Versus Delayed Initiation After 1 Year of Intramuscular Interferon Beta-1a in Patients With Multiple Sclerosis." Clinical Therapeutics, vol. 34, no. 7, 2012, pp. 1583-90.
Agashivala N, Kim E. Cost-effectiveness of early initiation of fingolimod versus delayed initiation after 1 year of intramuscular interferon beta-1a in patients with multiple sclerosis. Clin Ther. 2012;34(7):1583-90.
Agashivala, N., & Kim, E. (2012). Cost-effectiveness of early initiation of fingolimod versus delayed initiation after 1 year of intramuscular interferon beta-1a in patients with multiple sclerosis. Clinical Therapeutics, 34(7), 1583-90. https://doi.org/10.1016/j.clinthera.2012.06.012
Agashivala N, Kim E. Cost-effectiveness of Early Initiation of Fingolimod Versus Delayed Initiation After 1 Year of Intramuscular Interferon Beta-1a in Patients With Multiple Sclerosis. Clin Ther. 2012;34(7):1583-90. PubMed PMID: 22749258.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of early initiation of fingolimod versus delayed initiation after 1 year of intramuscular interferon beta-1a in patients with multiple sclerosis. AU - Agashivala,Neetu, AU - Kim,Edward, Y1 - 2012/06/28/ PY - 2012/05/01/received PY - 2012/06/06/revised PY - 2012/06/14/accepted PY - 2012/7/4/entrez PY - 2012/7/4/pubmed PY - 2012/12/22/medline SP - 1583 EP - 90 JF - Clinical therapeutics JO - Clin Ther VL - 34 IS - 7 N2 - BACKGROUND: Fingolimod is a once-daily orally administered disease-modifying therapy (DMT) indicated for treatment of relapsing forms of multiple sclerosis (MS) to reduce the frequency of clinical relapses and delay accumulation of physical disability. In the randomized, double-blind, phase 3 TRANSFORMS trial, 0.5 mg/d oral fingolimod substantially reduced relapse frequency when compared with IM interferon-β1a (IFN-β1a) at 12-months. In a 12-month, double-blind, extension phase of the TRANSFORMS study, patients assigned to receive fingolimod continued to receive the same dosage, whereas patients who originally received IM IFN-β1a were randomized to receive either 0.5 or 1.25 mg/d fingolimod. OBJECTIVE: To investigate the cost-effectiveness of initiating fingolimod therapy early versus after 1 year of IFN-β1a therapy using TRANSFORMS study extension data. METHODS: A Microsoft Excel-based model was used to calculate the cost per relapse avoided for 2 years with continuous treatment with fingolimod compared with first-year treatment with IM IFN-β1a and second-year treatment with fingolimod. One-way sensitivity analyses were conducted on key input variables to assess their effect on cost per relapse avoided. RESULTS: The 2-year relapse rate in the early fingolimod arm was 0.23, and in the delayed fingolimod arm was 0.53. The cost per relapse avoided was $83,125 in the early fingolimod arm versus $103,624 in the delayed fingolimod arm. Results of the sensitivity analyses showed an effect of drug acquisition cost and number of relapses in patients who received no treatment. CONCLUSION: Continuous treatment with fingolimod for 2 years resulted in a lower cost per relapse avoided compared with treatment with IM IFN-β1a for the first year and then switching to fingolimod therapy. Thus, delaying fingolimod therapy does not seem to be cost effective. SN - 1879-114X UR - https://www.unboundmedicine.com/medline/citation/22749258/Cost_effectiveness_of_early_initiation_of_fingolimod_versus_delayed_initiation_after_1_year_of_intramuscular_interferon_beta_1a_in_patients_with_multiple_sclerosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(12)00375-X DB - PRIME DP - Unbound Medicine ER -