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. 2023 Mar;7(2):229-241.
doi: 10.1007/s41669-022-00381-z. Epub 2022 Dec 1.

Cost-effectiveness Analysis of Ocrelizumab for the Treatment of Relapsing and Primary Progressive Multiple Sclerosis in Portugal

Paulo Martins  1 , Björn Vandewalle  1 , Jorge Félix  1 , Carlos M Capela  2 , João J Cerqueira  3 , António V Salgado  4 , Diana G Ferreira  5 , Isabel Monteiro  6
Affiliations

Cost-effectiveness Analysis of Ocrelizumab for the Treatment of Relapsing and Primary Progressive Multiple Sclerosis in Portugal

Paulo Martins et al. Pharmacoecon Open. 2023 Mar.

Abstract

Objectives: Ocrelizumab demonstrated significant clinical benefit for the treatment of relapsing (RMS) and primary progressive (PPMS) multiple sclerosis (MS), an incurable disease characterized by disability progression. This study evaluated the clinical and economic impact of ocrelizumab relative to current clinical practice, including other disease-modifying therapies (DMT), available in Portugal.

Methods: Markov models for MS were adapted to estimate the impact of ocrelizumab across three patient populations: treatment-naïve RMS, previously treated RMS, and PPMS. Health states were defined according to the Expanded Disability Status Scale. For RMS, the model further captured the occurrence of relapses and progression to secondary progressive multiple sclerosis (SPMS). A lifetime time-horizon and Portuguese societal perspective were adopted.

Results: For RMS patients, ocrelizumab was estimated to maximize the expected time (years) without progression to SPMS (10.50) relative to natalizumab (10.10), dimethyl fumarate (8.64), teriflunomide (8.39), fingolimod (8.38), interferon β-1a (8.33) and glatiramer acetate (8.18). As the most effective option, with quality-adjusted life year (QALY) gains between 0.3 and 1.2, ocrelizumab was found to be cost-saving relative to natalizumab and fingolimod, and presented incremental cost-effectiveness ratios (ICER) below €16,720/QALY relative to the remaining DMT. For PPMS patients, the ICER of ocrelizumab versus best supportive care was estimated at €78,858/QALY.

Conclusions: Ocrelizumab provides important health benefits for RMS and PPMS patients, comparing favourably with other widely used therapies. In RMS, ocrelizumab was revealed to be either cost-saving or have costs-per-QALY likely below commonly accepted cost-effectiveness thresholds. In PPMS, ocrelizumab fills a clear clinical gap in the current clinical practice. Overall, ocrelizumab is expected to provide good value for money in addressing the need of MS patients.

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Conflict of interest statement

PM, BV and JF are employed by Exigo Consultores. The study sponsor contracted with Exigo Consultores for the development of the research project. Exigo Consultores provided support in the form of salaries for authors but did not have any additional role in the study design, data collection and analysis, or preparation of the manuscript. CC has received compensation for advisory board/consulting services to Biogen, Janssen, Merck, Novartis, Roche, and Sanofi, and has been on the speakers’ bureau for Almirall, Biogen, BMS, Janssen, Merck, Novartis, Roche, and Sanofi. JC has received compensation for activity with Almirall, Biogen, Bristol-Myers-Squibb, Janssen, Merck, Novartis, Roche, Sanofi, and Zambon. AS has received compensation for activity with Astra Zeneca, Biogen, Merck, Novartis, Roche, and Sanofi. DF and IM are employees of Roche Farmacêutica e Química, Lda., Portugal.

Figures

Fig. 1
Fig. 1
Cost-effectiveness plane for RMS. QALYs quality-adjusted life years, RMS relapsing multiple sclerosis
Fig. 2
Fig. 2
Cost-effectiveness acceptability curve for a RMS and b PPMS. PPMS primary progressive multiple sclerosis, RMS relapsing multiple sclerosis
See this image and copyright information in PMC

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