FROM INCORPORATION TO IMPACT: REAL-WORLD BUDGET ADVANTAGE OF CLADRIBINE IN MULTIPLE SCLEROSIS WITHIN A BRAZILIAN PRIVATE HEALTH PLAN
Author(s)
JOSE MARIO ALVES JUNIOR, PhD, Ana Carolina Furian da Silva, MS, Nathalia Maria Mascarenhas Munhoes, MD, Indyanara Inacio Barreto, MS, Fatima Filomena Mafra Christoforo, PhD, Bartira Guicardi Vercelino, MD, Aline de Oliveira Podadera, MD, Jose Emilio Duran Bueno, MD.
UNIMED CAMPINAS, CAMPINAS, Brazil.
UNIMED CAMPINAS, CAMPINAS, Brazil.
OBJECTIVES: To evaluate the real-world economic and clinical impact of cladribine after its incorporation into the therapeutic algorithm of a large Brazilian private health plan (Unimed Campinas). Outcomes included changes in healthcare resource utilization, multiple sclerosis-specific costs (ICD G35), and a 4-year budget impact comparison versus natalizumab and ocrelizumab. This analysis extends prior cost-effectiveness and budget impact studies within the same population.
METHODS: A retrospective cohort study was conducted using administrative claims data. Patients with ≥6 months of cladribine treatment were included (n=22). Equivalent pre- and post-treatment periods were compared. Direct costs of disease-modifying therapies were excluded from utilization analyses and evaluated separately in a budget impact model. Variables assessed included consultations, hospitalizations, ICU use, diagnostic imaging, laboratory tests, emergency visits, and procedures. A secondary analysis isolated MS-specific costs. A 4-year budget impact model compared cladribine, natalizumab, and ocrelizumab assuming identical cohorts.
RESULTS: Total healthcare utilization costs decreased from US$56,350 before cladribine to US$16,370 after initiation, a 71% reduction. Major decreases occurred in hospital bed-days (−89%), diagnostic imaging (−66%), consultations (−51%), emergency visits (−69%), and laboratory tests (−48%).
In the MS-specific analysis, costs decreased from US$21,370 to US$10,450, representing a 51% reduction, driven by reductions in consultations (−72%), hospitalizations (−80%), imaging (−53%), and procedures (−87%).
The 4-year budget impact for the 22-patient cohort was lowest for cladribine at US$1.286 million, compared with US$1.448 million for natalizumab and US$2.754 million for ocrelizumab. Given cladribine’s front-loaded cost structure (years 1-2), full economic benefit depends on long-term treatment persistence.
CONCLUSIONS: Cladribine substantially reduced healthcare resource utilization and MS-related costs in real-world practice. It also demonstrated the lowest 4-year budget impact compared with natalizumab and ocrelizumab, reinforcing its economic advantage for private payers. Continuous monitoring of treatment adherence and persistence is recommended to maximize clinical and economic outcomes.
METHODS: A retrospective cohort study was conducted using administrative claims data. Patients with ≥6 months of cladribine treatment were included (n=22). Equivalent pre- and post-treatment periods were compared. Direct costs of disease-modifying therapies were excluded from utilization analyses and evaluated separately in a budget impact model. Variables assessed included consultations, hospitalizations, ICU use, diagnostic imaging, laboratory tests, emergency visits, and procedures. A secondary analysis isolated MS-specific costs. A 4-year budget impact model compared cladribine, natalizumab, and ocrelizumab assuming identical cohorts.
RESULTS: Total healthcare utilization costs decreased from US$56,350 before cladribine to US$16,370 after initiation, a 71% reduction. Major decreases occurred in hospital bed-days (−89%), diagnostic imaging (−66%), consultations (−51%), emergency visits (−69%), and laboratory tests (−48%).
In the MS-specific analysis, costs decreased from US$21,370 to US$10,450, representing a 51% reduction, driven by reductions in consultations (−72%), hospitalizations (−80%), imaging (−53%), and procedures (−87%).
The 4-year budget impact for the 22-patient cohort was lowest for cladribine at US$1.286 million, compared with US$1.448 million for natalizumab and US$2.754 million for ocrelizumab. Given cladribine’s front-loaded cost structure (years 1-2), full economic benefit depends on long-term treatment persistence.
CONCLUSIONS: Cladribine substantially reduced healthcare resource utilization and MS-related costs in real-world practice. It also demonstrated the lowest 4-year budget impact compared with natalizumab and ocrelizumab, reinforcing its economic advantage for private payers. Continuous monitoring of treatment adherence and persistence is recommended to maximize clinical and economic outcomes.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE32
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
SDC: Neurological Disorders, STA: Biologics & Biosimilars