BUDGET IMPACT ANALYSIS OF OFATUMUMAB FOR RELAPSING-REMITTING MULTIPLE SCLEROSIS IN MOROCCO: A PROBABILISTIC MULTI-SCENARIO ASSESSMENT FROM THE PUBLIC PAYER PERSPECTIVE
Author(s)
Omar Maoujoud, PhD, MD1, sanaa haouraji, Msc2;
11Resarch team of Pharmacoeconomics & Pharmacoepidemiology, Moroccan Society of healt economics (SMEPS), Facuty of Medicine, Mohamed V university Rbat Morocco, Rabat, Morocco, Rabat, Morocco, 2EOS Executive Lab, Casablanca, Morocco
11Resarch team of Pharmacoeconomics & Pharmacoepidemiology, Moroccan Society of healt economics (SMEPS), Facuty of Medicine, Mohamed V university Rbat Morocco, Rabat, Morocco, Rabat, Morocco, 2EOS Executive Lab, Casablanca, Morocco
OBJECTIVES: To conduct a comprehensive budget impact analysis (BIA) of ofatumumab for relapsing-remitting multiple sclerosis (RRMS) from the Moroccan public payer perspective, quantifying cost drivers and characterizing decision uncertainty through deterministic and probabilistic sensitivity analyses
METHODS: A prevalence-based BIA model compliant with ISPOR BIA Good Practice Guidelines was developed. The target population comprised RRMS patients with inadequate response to platform therapies (Year 1: n=2,123; growth rate: 1.7%/year). Market dynamics modeled progressive ofatumumab uptake (3.1%-25.6% over 5 years) with displacement from existing DMT mix. Cost components included: drug acquisition, administration, monitoring, and relapse management ($950/event; 95%CI: $713-$1,188). Clinical parameters derived from pooled ASCLEPIOS I/II data (ARR: 0.11; 95%CI: 0.09-0.14; HR disability progression: 0.66; 95%CI: 0.50-0.86). One-way sensitivity analysis (OWSA) evaluated ±20% parameter variation. Threshold analysis identified budget-neutrality conditions. Probabilistic sensitivity analysis (PSA; 10,000 Monte Carlo iterations) propagated parametric uncertainty using beta distributions (efficacy), gamma distributions (costs), and Dirichlet distributions (market shares). Results expressed in 2024 USD (1 USD=10 MAD); 5-year undiscounted horizon.
RESULTS: Base-case cumulative budget impact was +$3.05M (+2.25% vs reference). Cost decomposition: drug acquisition +$3.59M, relapse offsets -$543K (571 events avoided). OWSA tornado analysis ranked influential parameters: market share uptake (range: +$1.83M to +$4.27M), ARR differential (±$0.41M), relapse unit cost (±$0.27M). Threshold analysis demonstrated budget neutrality at 12.8% price reduction. PSA yielded mean impact +$3.12M (95%CI: +$1.89M to +$4.58M); probability of exceeding +$4M threshold: 18.7%. Scenario analyses confirmed robustness: conservative efficacy (+$3.41M), accelerated uptake (+$4.12M), reduced relapse costs (+$2.78M)
CONCLUSIONS: Ofatumumab introduction generates predictable, modest budget impact with quantified uncertainty bounds. Relapse-related savings offset 15.1% of incremental drug expenditure. PSA and scenario analyses demonstrate model robustness, providing transparent evidence for formulary decision-making in resource-constrained settings
METHODS: A prevalence-based BIA model compliant with ISPOR BIA Good Practice Guidelines was developed. The target population comprised RRMS patients with inadequate response to platform therapies (Year 1: n=2,123; growth rate: 1.7%/year). Market dynamics modeled progressive ofatumumab uptake (3.1%-25.6% over 5 years) with displacement from existing DMT mix. Cost components included: drug acquisition, administration, monitoring, and relapse management ($950/event; 95%CI: $713-$1,188). Clinical parameters derived from pooled ASCLEPIOS I/II data (ARR: 0.11; 95%CI: 0.09-0.14; HR disability progression: 0.66; 95%CI: 0.50-0.86). One-way sensitivity analysis (OWSA) evaluated ±20% parameter variation. Threshold analysis identified budget-neutrality conditions. Probabilistic sensitivity analysis (PSA; 10,000 Monte Carlo iterations) propagated parametric uncertainty using beta distributions (efficacy), gamma distributions (costs), and Dirichlet distributions (market shares). Results expressed in 2024 USD (1 USD=10 MAD); 5-year undiscounted horizon.
RESULTS: Base-case cumulative budget impact was +$3.05M (+2.25% vs reference). Cost decomposition: drug acquisition +$3.59M, relapse offsets -$543K (571 events avoided). OWSA tornado analysis ranked influential parameters: market share uptake (range: +$1.83M to +$4.27M), ARR differential (±$0.41M), relapse unit cost (±$0.27M). Threshold analysis demonstrated budget neutrality at 12.8% price reduction. PSA yielded mean impact +$3.12M (95%CI: +$1.89M to +$4.58M); probability of exceeding +$4M threshold: 18.7%. Scenario analyses confirmed robustness: conservative efficacy (+$3.41M), accelerated uptake (+$4.12M), reduced relapse costs (+$2.78M)
CONCLUSIONS: Ofatumumab introduction generates predictable, modest budget impact with quantified uncertainty bounds. Relapse-related savings offset 15.1% of incremental drug expenditure. PSA and scenario analyses demonstrate model robustness, providing transparent evidence for formulary decision-making in resource-constrained settings
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE456
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Neurological Disorders