Clinical and Economic Impact of Early Treatment in Relapsing Remitting Multiple Sclerosis With High-Efficacy Disease-Modifying Therapy in Mexico
Author(s)
MARGARITA FUENTES LOPEZ1, ILIANA GONZALEZ, MD2, KARINA CARRILLO, MD3, VICTOR GASCA, MD3.
1MERCK, ESTADO DE MEXICO, Mexico, 2MERCK, Mexico City, Mexico, 3Instituto Mexicano del Seguro Social, Mexico City, Mexico.
1MERCK, ESTADO DE MEXICO, Mexico, 2MERCK, Mexico City, Mexico, 3Instituto Mexicano del Seguro Social, Mexico City, Mexico.
OBJECTIVES: To estimate the clinical and economic impact of early use of high efficacy disease modifying therapies (DMTs) for relapsing remitting multiple sclerosis (RRMS), by comparing four treatment strategies currently used in Mexico: (1) no DMT (symptomatic treatment), (2) moderate efficacy DMTs (interferons, glatiramer acetate, teriflunomide, dimethyl fumarate), (3) escalation (starting with moderate efficacy DMTs and switching to high efficacy DMTs after five years: cladribine, fingolimod, alemtuzumab, ocrelizumab, natalizumab, ofatumumab), and (4) early initiation with high efficacy DMTs.
METHODS: A cost consequence analysis was conducted using a Markov model with four health states: mild disability (EDSS <4), moderate disability (EDSS 4, 5.5), severe disability (EDSS ≥6), and death. A cohort of adult patients with RRMS was simulated over a 15 year horizon with annual cycles. Transition probabilities were based on published disease progression data. Direct medical, non medical, and indirect costs were assigned by disability level, discounted at 5% annually, and reported in 2025 USD.
RESULTS: Scenario 4 (early initiation with high efficacy DMTs) showed the best clinical outcomes. Life years gained (LYG) were highest in scenarios 3 and 4 (15.0), compared to 14.7 and 13.9 in scenarios 2 and 1, respectively. Scenario 4 also had the greatest number of years lived with mild disability (12.8 vs. 9.3, 9.5, 9.5), and it eliminated years lived with severe disability and years of life lost. Economically, the total cost for scenario 4 was $173,236.01 USD, which is lower than the escalation scenario, which was $13,183.61 USD more expensive and 12.1% and 19.5% higher than scenarios 1 and 2, respectively.
CONCLUSIONS: Early initiation with high-efficacy DMTs represents the most favorable strategy in terms of clinical outcomes and costs, maximizing life years gained and significantly improving patients' quality of life. Findings support eliminating escalation as a therapeutic option and prioritizing early high-efficacy treatment in RRMS in Mexico.
METHODS: A cost consequence analysis was conducted using a Markov model with four health states: mild disability (EDSS <4), moderate disability (EDSS 4, 5.5), severe disability (EDSS ≥6), and death. A cohort of adult patients with RRMS was simulated over a 15 year horizon with annual cycles. Transition probabilities were based on published disease progression data. Direct medical, non medical, and indirect costs were assigned by disability level, discounted at 5% annually, and reported in 2025 USD.
RESULTS: Scenario 4 (early initiation with high efficacy DMTs) showed the best clinical outcomes. Life years gained (LYG) were highest in scenarios 3 and 4 (15.0), compared to 14.7 and 13.9 in scenarios 2 and 1, respectively. Scenario 4 also had the greatest number of years lived with mild disability (12.8 vs. 9.3, 9.5, 9.5), and it eliminated years lived with severe disability and years of life lost. Economically, the total cost for scenario 4 was $173,236.01 USD, which is lower than the escalation scenario, which was $13,183.61 USD more expensive and 12.1% and 19.5% higher than scenarios 1 and 2, respectively.
CONCLUSIONS: Early initiation with high-efficacy DMTs represents the most favorable strategy in terms of clinical outcomes and costs, maximizing life years gained and significantly improving patients' quality of life. Findings support eliminating escalation as a therapeutic option and prioritizing early high-efficacy treatment in RRMS in Mexico.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE130
Topic
Clinical Outcomes, Economic Evaluation, Health Policy & Regulatory
Disease
Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas