Cost Savings From Patient Preference-Based Allocation of High-Efficacy Therapies for MS: Evidence From Switzerland
Author(s)
Marc Bill, MSc1, Michael E. Arzt, PhD2, Andrew Chan, Prof. Dr. med.3, Lara Diem, Dr. med.4, Barbara Fischer, PhD1, Florian Kuhlmey, PhD1, Pascal A. Rabatscher, PhD2.
1Polynomics AG, Olten, Switzerland, 2Novartis Pharma Schweiz AG, Rotkreuz, Switzerland, 3Department of Neurology, University Hospital Bern (Inselspital), Bern, Switzerland, 4Kantonsspital Luzern, Luzern, Switzerland.
1Polynomics AG, Olten, Switzerland, 2Novartis Pharma Schweiz AG, Rotkreuz, Switzerland, 3Department of Neurology, University Hospital Bern (Inselspital), Bern, Switzerland, 4Kantonsspital Luzern, Luzern, Switzerland.
OBJECTIVES: High-efficacy therapies (HET) for relapsing multiple sclerosis (MS) improve disease control but impose an economic burden on the healthcare system. In 2024, four parenteral HETs with distinct administration modalities were available in Switzerland: ocrelizumab (i.v., administered every six months), natalizumab (s.c. or i.v., administered monthly), and ofatumumab (s.c., self-administered monthly at home). This study uses cost-minimization analysis (CMA) to estimate the societal cost impact of allocating HETs based on patient preferences.
METHODS: We conducted a population-level CMA from a societal perspective. HET-specific utilization was estimated from national sales data, and the treated population size was inferred from yearly dose equivalents. Annual per-patient costs included drug acquisition, direct administration costs (using billing data), and indirect costs from productivity losses (from wage data and expert-validated time assumptions). Total costs were estimated for observed HET utilization and for a counterfactual distribution based on administration preferences from a discrete choice experiment among MS patients.
RESULTS: Ofatumumab had the lowest annual cost (EUR 16,100 per patient), incurring no administration or indirect costs. Ocrelizumab (i.v.) was EUR 5,800 more costly, primarily due to higher drug prices (+EUR 4,500) and administration costs (+EUR 900). Natalizumab had even higher incremental costs (s.c. EUR 8,000, i.v. EUR 10,000). Based on estimated real-world HET utilization (66% ocrelizumab i.v., 21% ofatumumab, 9% natalizumab i.v., 4% natalizumab s.c.) and 7,067 patients, treatment-related HET-costs reached EUR 149 million. A reallocation reflecting stated patient preferences for administration profiles would shift HET-utilization toward ofatumumab (68%), reducing costs by EUR 17 million annually (−12%). Sensitivity analysis reveals drug prices and administration frequency as key cost drivers.
CONCLUSIONS: This CMA shows that pen-at-home administration - favored by most patients - can offer substantial cost savings compared to more resource-intensive regimens. These findings suggest that educating patients about administration options may support preference-aligned treatment choices and improve resource efficiency.
METHODS: We conducted a population-level CMA from a societal perspective. HET-specific utilization was estimated from national sales data, and the treated population size was inferred from yearly dose equivalents. Annual per-patient costs included drug acquisition, direct administration costs (using billing data), and indirect costs from productivity losses (from wage data and expert-validated time assumptions). Total costs were estimated for observed HET utilization and for a counterfactual distribution based on administration preferences from a discrete choice experiment among MS patients.
RESULTS: Ofatumumab had the lowest annual cost (EUR 16,100 per patient), incurring no administration or indirect costs. Ocrelizumab (i.v.) was EUR 5,800 more costly, primarily due to higher drug prices (+EUR 4,500) and administration costs (+EUR 900). Natalizumab had even higher incremental costs (s.c. EUR 8,000, i.v. EUR 10,000). Based on estimated real-world HET utilization (66% ocrelizumab i.v., 21% ofatumumab, 9% natalizumab i.v., 4% natalizumab s.c.) and 7,067 patients, treatment-related HET-costs reached EUR 149 million. A reallocation reflecting stated patient preferences for administration profiles would shift HET-utilization toward ofatumumab (68%), reducing costs by EUR 17 million annually (−12%). Sensitivity analysis reveals drug prices and administration frequency as key cost drivers.
CONCLUSIONS: This CMA shows that pen-at-home administration - favored by most patients - can offer substantial cost savings compared to more resource-intensive regimens. These findings suggest that educating patients about administration options may support preference-aligned treatment choices and improve resource efficiency.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE187
Topic
Economic Evaluation, Health Policy & Regulatory
Topic Subcategory
Work & Home Productivity - Indirect Costs
Disease
Neurological Disorders