Cost-consequence analysis of ofatumumab for the treatment of relapsing-remitting multiple sclerosis in Canada

Abstract

Aim: The costs and consequences of initial and delayed ofatumumab treatment were evaluated in relapsing-remitting multiple sclerosis with active disease in Canada. Materials & methods: A Markov cohort model was used (10-year horizon, annual cycle length, 1.5% discounting). Scenario analyses examined ofatumumab as first-line treatment versus 3 and 5 years following switch from commonly used first-line therapies. Results: Ofatumumab resulted in improvements in clinical outcomes (relapses and disease progression) and productivity (employment and full-time work), and reduction of economic burden (administration, monitoring and non-drug costs) that were comparable to other high-efficacy therapies (ocrelizumab, cladribine and natalizumab). Switching to ofatumumab earlier in the disease course may improve these outcomes. Conclusion: Results highlight the value of a high-efficacy therapy such as ofatumumab as initial treatment (i.e., first-line) in newly diagnosed relapsing-remitting multiple sclerosis patients with active disease.

Trial registration: ClinicalTrials.gov NCT02792218 NCT02792231.

Keywords: Canada; cost-consequence; disease-modifying therapy; multiple sclerosis; ofatumumab.

Figure 1.. Model structure.

Rounded rectangles on top represent health states and rounded rectangles on the bottom represent events that patients could experience at any time. Patients who reached an EDSS score of ≥7 (denoted by grey boxes) while on treatment would discontinue treatment and receive BSC. BSC: Best supportive care; EDSS: Expanded disability status scale.

Figure 2.. Base case clinical outcomes.

(A) Percent of patient time spent in each health state over a 10-year horizon for first-line and second-line treatments without treatment switching or delay. (B) Average percent of patient time spent in each health state over a 10-year time horizon for high-efficacy versus moderate-efficacy DMTs and BSC. (C) Percent of patient distribution in each EDSS health state at 10 years for first-line and second-line treatments without treatment switching or delay. (D) Average percent of patient distribution in each EDSS health state at 10 years for high-efficacy versus moderate-efficacy DMTs and BSC. (E) Number of relapse events over a 10-year time horizon for first-line and second-line treatments without treatment switching or delay. (F) Average number of relapse events over a 10-year time horizon for high-efficacy versus moderate-efficacy DMTs and BSC. (G) Number of DALYs over a 10-year horizon for first-line and second-line treatments without treatment switching or delay. (H) Average number of DALYs over a 10-year time horizon for high-efficacy versus moderate-efficacy DMTs and BSC. High-efficacy DMTs include ofatumumab, ocrelizumab, cladribine, and natalizumab. Moderate-efficacy DMTs include teriflunomide, dimethyl fumarate, glatiramer acetate, Avonex, Rebif 44, Betaseron, Extavia, and fingolimod. Bars to the left and right of the red line represent first-line and second-line therapies, respectively (A, C, E, G). Values in red text above bars show percent change versus ofatumumab (E & G). BSC: Best supportive care; DALY: Disability-adjusted life years, DMT: Disease-modifying therapies, EDSS: Expanded Disability Status Scale, EDSS 7+: Expanded Disability Status Scale 7 or above.

Figure 2.. Base case clinical outcomes.

(A) Percent of patient time spent in each health state over a 10-year horizon for first-line and second-line treatments without treatment switching or delay. (B) Average percent of patient time spent in each health state over a 10-year time horizon for high-efficacy versus moderate-efficacy DMTs and BSC. (C) Percent of patient distribution in each EDSS health state at 10 years for first-line and second-line treatments without treatment switching or delay. (D) Average percent of patient distribution in each EDSS health state at 10 years for high-efficacy versus moderate-efficacy DMTs and BSC. (E) Number of relapse events over a 10-year time horizon for first-line and second-line treatments without treatment switching or delay. (F) Average number of relapse events over a 10-year time horizon for high-efficacy versus moderate-efficacy DMTs and BSC. (G) Number of DALYs over a 10-year horizon for first-line and second-line treatments without treatment switching or delay. (H) Average number of DALYs over a 10-year time horizon for high-efficacy versus moderate-efficacy DMTs and BSC. High-efficacy DMTs include ofatumumab, ocrelizumab, cladribine, and natalizumab. Moderate-efficacy DMTs include teriflunomide, dimethyl fumarate, glatiramer acetate, Avonex, Rebif 44, Betaseron, Extavia, and fingolimod. Bars to the left and right of the red line represent first-line and second-line therapies, respectively (A, C, E, G). Values in red text above bars show percent change versus ofatumumab (E & G). BSC: Best supportive care; DALY: Disability-adjusted life years, DMT: Disease-modifying therapies, EDSS: Expanded Disability Status Scale, EDSS 7+: Expanded Disability Status Scale 7 or above.

Figure 3.. Base case productivity outcomes.

(A) Percent of individuals employed and working full time at 10 years for first-line and second-line treatments without treatment switching or delay. High-efficacy DMTs include ofatumumab, ocrelizumab, cladribine and natalizumab. Moderate-efficacy DMTs include teriflunomide, dimethyl fumarate, glatiramer acetate, Avonex, Rebif 44, Betaseron, Extavia and fingolimod. Bars to the left and right of the red line are first-line and second-line therapies, respectively. (B) Average percent of individuals employed and working full time at 10 years for high-efficacy versus moderate-efficacy DMTs and BSC. BSC: Best supportive care, DMT: Disease-modifying therapy.

Figure 4.. Delayed treatment scenario results over a 10-year time horizon for ofatumumab provided initially versus switching to ofatumumab after 3 and 5 years of treatment with another commonly used first-line disease-modifying therapy.

(A) Percent of patient time spent in each health state over a 10-year time horizon. (B) Number of relapse events over a 10-year time horizon. (C) Number of DALYs over a 10-year time horizon. (D) Percent of patients at EDSS 7+ at 10 years. (E) Percent of individuals employed at 10 years. Values in red text above bars show percent change versus ofatumumab (B–E). DALY: Disability-adjusted life years; DMT: Disease-modifying therapy; EDSS: Expanded Disability Status Scale; EDSS 7+ -: Expanded Disability Status Scale 7 or above.

Figure 4.. Delayed treatment scenario results over a 10-year time horizon for ofatumumab provided initially versus switching to ofatumumab after 3 and 5 years of treatment with another commonly used first-line disease-modifying therapy.

(A) Percent of patient time spent in each health state over a 10-year time horizon. (B) Number of relapse events over a 10-year time horizon. (C) Number of DALYs over a 10-year time horizon. (D) Percent of patients at EDSS 7+ at 10 years. (E) Percent of individuals employed at 10 years. Values in red text above bars show percent change versus ofatumumab (B–E). DALY: Disability-adjusted life years; DMT: Disease-modifying therapy; EDSS: Expanded Disability Status Scale; EDSS 7+ -: Expanded Disability Status Scale 7 or above.