Comparative Effectiveness and Cost-Effectiveness of Natalizumab and Fingolimod in Patients with Inadequate Response to Disease-Modifying Therapies in Relapsing-Remitting Multiple Sclerosis in the United Kingdom

Timothy Spelman, William L. Herring, Yuanhui Zhang, Michael Tempest, Isobel Pearson, Ulrich Freudensprung, Carlos Acosta (), Thibaut Dort, Robert Hyde, Eva Havrdova, Dana Horakova, Maria Trojano, Giovanna Luca, Alessandra Lugaresi, Guillermo Izquierdo, Pierre Grammond, Pierre Duquette, Raed Alroughani, Eugenio Pucci, Franco Granella, Jeannette Lechner-Scott, Patrizia Sola, Diana Ferraro, Francois Grand’Maison, Murat Terzi, Csilla Rozsa, Cavit Boz, Raymond Hupperts, Vincent Pesch, Celia Oreja-Guevara, Anneke Walt, Vilija G. Jokubaitis, Tomas Kalincik and Helmut Butzkueven
Additional contact information
Timothy Spelman: Monash University
William L. Herring: RTI Health Solutions
Yuanhui Zhang: RTI Health Solutions
Michael Tempest: Biogen
Isobel Pearson: RTI Health Solutions
Ulrich Freudensprung: Medical, Biogen
Carlos Acosta: Biogen International GmbH
Thibaut Dort: Biogen International GmbH
Robert Hyde: Medical, Biogen
Eva Havrdova: General University Hospital and Charles University
Dana Horakova: General University Hospital and Charles University
Maria Trojano: University of Bari
Giovanna Luca: University “G. d’Annunzio”
Alessandra Lugaresi: IRCCS Istituto delle Scienze Neurologiche di Bologna
Guillermo Izquierdo: Hospital Universitario Virgen Macarena
Pierre Grammond: Centre de Réadaptation Déficience Physique Chaudière-Appalache
Pierre Duquette: Hôpital Notre Dame
Raed Alroughani: Amiri Hospital
Eugenio Pucci: ASUR Marche-AV3
Franco Granella: University of Parma
Jeannette Lechner-Scott: John Hunter Hospital
Patrizia Sola: Azienda Ospedaliero Universitaria Policlinico/OCB, Neurology Unit
Diana Ferraro: University of Modena and Reggio Emilia
Francois Grand’Maison: Neuro Rive-Sud, Hôpital Charles LeMoyne
Murat Terzi: Mayis University
Csilla Rozsa: Jahn Ferenc Teaching Hospital
Cavit Boz: Karadeniz Technical University
Raymond Hupperts: Zuyderland Medical Center
Vincent Pesch: Cliniques Universitaires Saint-Luc
Celia Oreja-Guevara: Hospital ClínicoSan Carlos
Anneke Walt: Monash University
Vilija G. Jokubaitis: Monash University
Tomas Kalincik: University of Melbourne
Helmut Butzkueven: Monash University

PharmacoEconomics, 2022, vol. 40, issue 3, No 7, 323-339

Abstract: Abstract Background Patients with highly active relapsing-remitting multiple sclerosis inadequately responding to first-line therapies (interferon-based therapies, glatiramer acetate, dimethyl fumarate, and teriflunomide, known collectively as “BRACETD”) often switch to natalizumab or fingolimod. Objective The aim was to estimate the comparative effectiveness of switching to natalizumab or fingolimod or within BRACETD using real-world data and to evaluate the cost-effectiveness of switching to natalizumab versus fingolimod using a United Kingdom (UK) third-party payer perspective. Methods Real-world data were obtained from MSBase for patients relapsing on BRACETD in the year before switching to natalizumab or fingolimod or within BRACETD. Three-way-multinomial-propensity-score–matched cohorts were identified, and comparisons between treatment groups were conducted for annualised relapse rate (ARR) and 6-month–confirmed disability worsening (CDW6M) and improvement (CDI6M). Results were applied in a cost-effectiveness model over a lifetime horizon using a published Markov structure with health states based on the Expanded Disability Status Scale. Other model parameters were obtained from the UK MS Survey 2015, published literature, and publicly available UK sources. Results The MSBase analysis found a significant reduction in ARR (rate ratio [RR] = 0.64; 95% confidence interval [CI] 0.57–0.72; p

Date: 2022
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DOI: 10.1007/s40273-021-01106-6

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