Cost-Utility and Cost-Effectiveness Analysis Finds Oral DMTs Preferable to Injectables in Patients with RRMS

Multiple sclerosis (MS) is a progressive autoimmune disease characterized by demyelination and inflammation throughout the central nervous system. Symptoms range from mild to completely disabling and can include weakness, tingling, balance impairment, vision problems, cognitive impairment, and paralysis.

MS is categorized into different types based on the course of the disease and the pattern of symptom exacerbation and remission. About 85% of people with MS are initially diagnosed with relapsing-remitting MS (RRMS). Patients with RRMS have episodes of new or worsening symptoms (relapse) followed by periods of symptom recovery (remittance).

More frequent relapses and higher disability levels have been associated with increased risk of mortality, reduced quality of life, and increased healthcare costs. It is estimated that direct costs associated with MS can amount to up to $72,744 per patient per year.

The goal of MS treatment is to prevent or delay long-term disability. Disease-modifying therapies (DMTs) have been found to reduce the number of relapses and slow disability and disease progression. However, these treatments contribute significantly to the economic burden of MS management, accounting for up to 78% of direct MS costs.

To identify the most cost-effective treatment options for MS, a group of researchers led by Nasrin Abulhasanbeigi Gallehzan from the Health Management and Economics Research Center at Iran University of Medical Sciences in Tehran, Iran, conducted a systematic review of studies published between May 2001 and May 2023. The review results were recently published in Health Economics Review.

The study's purpose was to analyze cost-utility and cost-effectiveness of DMTs for RRMS, the most common form of MS. Gallehzan and his colleagues searched for studies published in English and Persian that examined cost-utility and cost-effectiveness of DMTs in patients with RRMS. Of the 1,589 studies found, 49 were included in the analysis.

The included studies analyzed first- and second-line treatments, and most reported incremental cost-effectiveness ratio (ICER) per different natural units, including quality of life years (QALYs). For first-line treatments, dimethyl fumarate, natalizumab, ozanimod, interferon beta 1a, ocrelizumab, ofatumumab, and teriflunomide were found to be the most cost-effective and yielded the most QALYs. When analyzing second-line treatments, ofatumumab and alemtuzumab came in as the most cost-effective and were associated with higher QALYs.

Overall, Gallehzan and his colleagues found that cladribine oral tablets and natalizumab intravenous (IV) infusion were the most cost-effective options for patients with highly active RRMS. However, they also observe that oral DMTs should be preferable to injectable treatments, including IV infusions, and care-oriented treatments, such as best supportive care and symptom management, “should be preferred to drug strategies and be considered a valuable early treatment option for patients with RRMS.”