Objective: To assess the costs of oral treatment with fingolimod compared to intravenous infusion of natalizumab in MSers with relapsing-remitting multiple sclerosis (RRMS) in the Netherlands.
Methods: A cost-minimization analysis was used to compare both treatments. The following cost categories were distinguished: drug acquisition costs, administration costs, and monitoring costs. Costs were discounted at 4%, and incremental model results were presented over a 1, 2, 5, and 10 year time horizon. The robustness of the results was determined by means of a number of deterministic univariate sensitivity analyses. Additionally, a break-even analysis was carried out to determine at which natalizumab infusion costs a cost neutral outcome would be obtained.
Results: Comparing fingolimod to natalizumab, the model predicted discounted incremental costs of -€2,966 (95%CI: -€4,209;-€1,801), -€6,240 (95%CI: -€8,800;-€3,879), -€15,328 (95%CI: -€21,539;-€9,692) and -€28,287 (95%CI: -€39,661;-€17,955) over a 1, 2, 5, and 10-year time horizon, respectively. These predictions were most sensitive to changes in the costs of natalizumab infusion. Changing these costs of €255 within a range from €165 to €364 per infusion, resulted in cost savings varying from €4,031 to €8,923 after 2 years. The additional break-even analysis showed that infusion costs - including aseptic preparation of the natalizumab solution - needed to be as low as the respective costs of €94 and €80 to obtain a cost neutral result after 2 and 10 years. Limitations Neither treatment discontinuation and subsequent re-initiation nor patient compliance were taken into account. As a consequence of the applied cost-minimization technique, only direct medical costs were included.
Conclusion: The present analysis showed that treatment with fingolimod resulted in considerable cost savings compared to natalizumab: starting at €2,966 in the first year, increasing to a total of €28,287 after 10 years per RRMS patient in the Netherlands.
Results: Comparing fingolimod to natalizumab, the model predicted discounted incremental costs of -€2,966 (95%CI: -€4,209;-€1,801), -€6,240 (95%CI: -€8,800;-€3,879), -€15,328 (95%CI: -€21,539;-€9,692) and -€28,287 (95%CI: -€39,661;-€17,955) over a 1, 2, 5, and 10-year time horizon, respectively. These predictions were most sensitive to changes in the costs of natalizumab infusion. Changing these costs of €255 within a range from €165 to €364 per infusion, resulted in cost savings varying from €4,031 to €8,923 after 2 years. The additional break-even analysis showed that infusion costs - including aseptic preparation of the natalizumab solution - needed to be as low as the respective costs of €94 and €80 to obtain a cost neutral result after 2 and 10 years. Limitations Neither treatment discontinuation and subsequent re-initiation nor patient compliance were taken into account. As a consequence of the applied cost-minimization technique, only direct medical costs were included.
Conclusion: The present analysis showed that treatment with fingolimod resulted in considerable cost savings compared to natalizumab: starting at €2,966 in the first year, increasing to a total of €28,287 after 10 years per RRMS patient in the Netherlands.
"The future of managed care will result in an increasing number of these kind of studies. Which drug is gives the biggest bang for buck spent? This is the aim of NICE in the UK; to ensure that the NHS gets the best value for money. What about MSer choice?"