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Cost-utility of fingolimod compared with dimethyl fumarate in highly active relapsing-remitting multiple sclerosis (RRMS) in England.
J Med Econ. 2015; 18(11):874-85.JM

Abstract

OBJECTIVE

The cost-effectiveness of new oral disease-modifying therapies (DMTs) has not been modeled in highly active (HA) relapsing-remitting multiple sclerosis (RRMS) requiring escalation therapy. This study sought to model the cost-effectiveness of fingolimod compared to dimethyl fumarate (DMF), for which relevant HA RRMS sub-group data were available, from the perspective of the National Health Service (NHS) in England.

METHODS

A cohort Markov model based on Expanded Disability Status Scale scores, similar to previous model designs, was constructed. Published post hoc clinical data in the HA RRMS sub-groups were taken from the pivotal trials for fingolimod and DMF vs placebo. Utility data for each health state and for relapses were used in line with previous similar models. Published costs were inflated to NHS cost year 2013-2014 and UK list prices used for both drugs. Possible Patient Access Scheme (PAS) discount scenarios were investigated.

RESULTS

In the base case, using list prices for each DMT, the average probabilistic incremental cost-effectiveness ratio (ICER) for fingolimod vs DMF was found to be £ 14,076, with a 73% chance of fingolimod being cost-effective at a willingness-to-pay threshold of £ 30,000. Scenario and sensitivity analyses showed that uncertainty in disability progression efficacy was a key model driver. The model was robust to other changes and the majority of PAS permutations do not contradict the base case finding of cost-effectiveness of fingolimod.

CONCLUSIONS

In conclusion, fingolimod remains cost-effective in HA RRMS following the introduction of DMF to the UK market, and this paper supports the evidence that has led fingolimod to be the only oral DMT reimbursed for HA RRMS in England. This model supports the restriction imposed by National Institute for Health and Care Excellence (NICE) on DMF in HA RRMS and highlights the importance of considering different sub-groups of multiple sclerosis when performing health economic analyses.

Authors+Show Affiliations

a a Costello Medical Consulting Ltd , Cambridge , UK.a a Costello Medical Consulting Ltd , Cambridge , UK.a a Costello Medical Consulting Ltd , Cambridge , UK.b b Novartis Pharma AG , Basel , Switzerland.c c Novartis Pharmaceuticals UK Ltd , Frimley , Surrey , UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26055952

Citation

Maruszczak, Maciej J., et al. "Cost-utility of Fingolimod Compared With Dimethyl Fumarate in Highly Active Relapsing-remitting Multiple Sclerosis (RRMS) in England." Journal of Medical Economics, vol. 18, no. 11, 2015, pp. 874-85.
Maruszczak MJ, Montgomery SM, Griffiths MJ, et al. Cost-utility of fingolimod compared with dimethyl fumarate in highly active relapsing-remitting multiple sclerosis (RRMS) in England. J Med Econ. 2015;18(11):874-85.
Maruszczak, M. J., Montgomery, S. M., Griffiths, M. J., Bergvall, N., & Adlard, N. (2015). Cost-utility of fingolimod compared with dimethyl fumarate in highly active relapsing-remitting multiple sclerosis (RRMS) in England. Journal of Medical Economics, 18(11), 874-85. https://doi.org/10.3111/13696998.2015.1056794
Maruszczak MJ, et al. Cost-utility of Fingolimod Compared With Dimethyl Fumarate in Highly Active Relapsing-remitting Multiple Sclerosis (RRMS) in England. J Med Econ. 2015;18(11):874-85. PubMed PMID: 26055952.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-utility of fingolimod compared with dimethyl fumarate in highly active relapsing-remitting multiple sclerosis (RRMS) in England. AU - Maruszczak,Maciej J, AU - Montgomery,Stephen M, AU - Griffiths,Matthew J S, AU - Bergvall,Niklas, AU - Adlard,Nicholas, Y1 - 2015/07/01/ PY - 2015/6/10/entrez PY - 2015/6/10/pubmed PY - 2016/8/9/medline KW - Cost-effectiveness KW - Cost-utility KW - Dimethyl fumarate KW - Fingolimod KW - Highly active relapsing-remitting multiple sclerosis KW - Multiple sclerosis SP - 874 EP - 85 JF - Journal of medical economics JO - J Med Econ VL - 18 IS - 11 N2 - OBJECTIVE: The cost-effectiveness of new oral disease-modifying therapies (DMTs) has not been modeled in highly active (HA) relapsing-remitting multiple sclerosis (RRMS) requiring escalation therapy. This study sought to model the cost-effectiveness of fingolimod compared to dimethyl fumarate (DMF), for which relevant HA RRMS sub-group data were available, from the perspective of the National Health Service (NHS) in England. METHODS: A cohort Markov model based on Expanded Disability Status Scale scores, similar to previous model designs, was constructed. Published post hoc clinical data in the HA RRMS sub-groups were taken from the pivotal trials for fingolimod and DMF vs placebo. Utility data for each health state and for relapses were used in line with previous similar models. Published costs were inflated to NHS cost year 2013-2014 and UK list prices used for both drugs. Possible Patient Access Scheme (PAS) discount scenarios were investigated. RESULTS: In the base case, using list prices for each DMT, the average probabilistic incremental cost-effectiveness ratio (ICER) for fingolimod vs DMF was found to be £ 14,076, with a 73% chance of fingolimod being cost-effective at a willingness-to-pay threshold of £ 30,000. Scenario and sensitivity analyses showed that uncertainty in disability progression efficacy was a key model driver. The model was robust to other changes and the majority of PAS permutations do not contradict the base case finding of cost-effectiveness of fingolimod. CONCLUSIONS: In conclusion, fingolimod remains cost-effective in HA RRMS following the introduction of DMF to the UK market, and this paper supports the evidence that has led fingolimod to be the only oral DMT reimbursed for HA RRMS in England. This model supports the restriction imposed by National Institute for Health and Care Excellence (NICE) on DMF in HA RRMS and highlights the importance of considering different sub-groups of multiple sclerosis when performing health economic analyses. SN - 1941-837X UR - https://www.unboundmedicine.com/medline/citation/26055952/Cost_utility_of_fingolimod_compared_with_dimethyl_fumarate_in_highly_active_relapsing_remitting_multiple_sclerosis__RRMS__in_England_ L2 - https://www.tandfonline.com/doi/full/10.3111/13696998.2015.1056794 DB - PRIME DP - Unbound Medicine ER -