COST-EFFECTIVENESS OF MULTIPLE SCLEROSIS DISEASE-MODIFYING THERAPY: ACCOUNTING FOR PATIENT RISK

Purpose: To determine the cost-effectiveness of glatiramer acetate (GA) and dimethyl fumarate (DMF) for patients with relapsing remitting multiple sclerosis who have different baseline risk for long-term disability.

Methods: We developed a multiple sclerosis (MS) disease natural history microsimulation model calibrated to a large London, Ontario longitudinal patient cohort whose long-term disability risk varied according to 20 patient characteristics. We evaluated three treatments: GA; DMF; and no drug, with treatment effectiveness expressed as hazard ratios compared to no drug derived from the CONFIRM trial. We considered clinical outcomes as well as discounted quality-adjusted life years (QALYs) and costs. We evaluated cost-effectiveness for all patients and for two groups of patients at high- and low-risk for long-term disease progression.

Results: At their full prices, DMTs yield health benefits at high costs relative to no drug treatment. If DMF's price were 85% lower, it would cost $100,000 per QALY gained compared to no drug; for GA to cost $100,000 per QALY gained compared to no drug, its price would have to be 94% lower. For clinical cases where DMT is indicated, at current prices, DMF costs $99,000 per QALY gained compared to GA. Relative to GA, DMF costs $83,000 per QALY for high-risk patients and $112,000 for low-risk patients. If DMF's price were 10% lower, it would be cost saving compared to GA for all patient groups.

Conclusions: Health gains from DMTs come at high cost. Assuming patients will be on a DMT, DMF provides better value for money compared to GA at current prices, especially for patients at high-risk of long-term disability, though even in this group compared to no drug the cost per QALY exceeds $500,000. Substantially reducing the prices of DMTs would improve their cost-effectiveness.