The cost-effectiveness of alemtuzumab in the management of relapse-remitting multiple sclerosis in Italy

Multiple sclerosis is the most frequent cause of non-traumatic neurologic disability in young adults with over 3400 newly diagnosed cases annually in Italy. The research objective was to assess the cost-effectiveness of alemtuzumab in comparison with other disease-modifying therapies in the management of relapsing-remitting multiple sclerosis, from a payer perspective in Italy. A Markov model was created to assess cost-effectiveness of alemtuzumab in comparison with subcutaneous IFN β-1a, natalizumab and fingolimod. Treatment effects were derived from a network meta-analysis. Economic input included cost of therapies, their administration and follow-up, cost of adverse events and cost of relapse. Data on health care resource utilization and their costs were retrieved from published sources. Cost-effectiveness was measured as incremental cost (€, 2017) per quality-adjusted life year while the robustness of the results was demonstrated in sensitivity analyses. Over a lifetime horizon, alemtuzumab yielded more quality-adjusted life years and less costs compared to the other disease-modifying therapies in all base-case analyses. Treatment with alemtuzumab yielded an incremental quality-adjusted life years of 1.62, 1.03 and 1.36 with savings of €4312, €81,562 and €54,067 versus IFN β-1a, fingolimod and natalizumab, respectively. Results on the multiple cost-effectiveness acceptability curve showed alemtuzumab carries the highest likelihood of being below the accepted willingness-to-pay threshold (€40,000) compared to IFN β-1a, natalizumab and fingolimod. Based on the current analysis, alemtuzumab is likely to be cost-effective versus IFN β-1a, natalizumab and fingolimod in the treatment of relapsing-remitting multiple sclerosis patients in Italy