Improving Outcomes and Resource Use in Multiple Sclerosis: What are the Benefits Associated With an Early Treatment Strategy With Fingolimod?

Objective: This analysis aims to estimate the cost-effectiveness of early treatment versus delayed treatment with fingolimod 0.5 mg/day in patients with relapsing-remitting multiple sclerosis. Study Type: Economic evaluation of health technologies Local: Portugal Population: Multiple sclerosis patients (MS) receiving treatment with fingolimod or interferon beta followed by fingolimod Methodology: A Microsoft Excel-based model was developed to estimate costs and health outcomes associated to two treatment strategies in MS: 1) early treatment with fingolimod -patients received treatment with 0.5 mg/day oral fingolimod continuously for 54 months; and 2) delayed treatment with fingolimod - patients received 12 months treatment with interferon beta-1a (IFN-β1a) followed by an additional 42 months of treatment with fingolimod (total of 54 months). The model estimates the total number of relapses associated with the different treatment strategies, the total treatment costs and the cost per relapse avoided. Effectiveness data was derived from the annualized relapse rate of TRANSFORMS and its extension phase. Health care resource use and local clinical practice was estimated based in local experts’ opinion. The study adopted the hospital perspective and only direct medical costs were included. The analysis considered a time horizon of 54 months, and costs and outcomes were discounted at a yearly rate of 5%. Final results are presented as incremental cost-effectiveness ratio. One-way sensitivity analysis was conducted on key inputs to assess their impact on final incremental cost-effectiveness ratio. Results: For a hypothetical cohort of 100 patient’s early treatment with fingolimod was more effective in avoiding relapses when compared to delayed treatment, less 44 relapses (64.10 relapses versus 103.35 for 100 patients after 54 months). Early treatment was associated with incremental costs (€562,165 for 100 patients after 54 months). The incremental cost-effectiveness ratio was €14.327/relapse avoided. Conclusions: Under the Portuguese hospital perspective, early treatment with fingolimod is expected to result in better clinical outcomes associated with a more efficient healthcare resources allocation