Microcosting Analysis of Oral, Subcutaneous, and Intravenous Second-line Multiple Sclerosis Treatments Administered at Home or in Hospital
Author(s)
Valérie J. van Hezik-Wester, PhD1, Emma L. Palsma, MSc1, Willem Bouvy, PhD2, Gerald Hengstman, PhD3, Britta Nijsse, PhD4, Kees Okkersen, PhD5, Esther Zeinstra, PhD6, Tim A. Kanters, PhD1.
1institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands, 2Diakonessenhuis, Utrecht, Netherlands, 3Upendo, Boxtel, Netherlands, 4Ziekenhuis Gelderse Vallei, Ede, Netherlands, 5Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands, 6Isala-Diaconessenhuis, Meppel, Netherlands.
1institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands, 2Diakonessenhuis, Utrecht, Netherlands, 3Upendo, Boxtel, Netherlands, 4Ziekenhuis Gelderse Vallei, Ede, Netherlands, 5Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands, 6Isala-Diaconessenhuis, Meppel, Netherlands.
OBJECTIVES: The MICRO-MARS study compares the societal costs associated with administering second-line disease-modifying treatments (DMTs) for adults with relapsing-remitting multiple sclerosis (RRMS) in the Netherlands, accounting for differences in routes of administration and treatment settings.
METHODS: An observational study using a bottom-up micro-costing approach was conducted. Costs were categorized into: (i) direct healthcare costs, (ii) patient and family costs, and (iii) productivity losses. Patients received either nurse-administered ocrelizumab or natalizumab intravenously (IV) at the hospital, or self-administered cladribine (oral) or ofatumumab (subcutaneous; SC) at home. Healthcare resource use related to administration—such as staff time, consumables, and diagnostics—was recorded using case report forms. Patient questionnaires provided data on caregiver time, travel expenses, and productivity losses. Analyses followed Dutch health economic guidelines.
RESULTS: 121 RRMS patients were recruited from five treatment centers: 40 patients received ocrelizumab, 33 natalizumab, 7 cladribine, and 41 ofatumumab. Administration-related healthcare costs were highest for hospital-based IV ocrelizumab (mean €103) and lowest for home-based oral cladribine (€7). Non-healthcare costs —comprising productivity losses, informal care, and travel— were higher for hospital-based therapies, primarily due to productivity losses. Average total costs per administration were €275 (SD €170) for ocrelizumab, €139 (SD €116) for natalizumab, €13 (SD €15) for cladribine, and €23 (SD €61) for ofatumumab. Assuming annual dosing schedules of 2 administrations for ocrelizumab, 10 for natalizumab, 9 for cladribine (note: treatment is completed after two years), and 12 for ofatumumab, the corresponding annual administration costs were €549, €1.388, €115, and €279, respectively.
CONCLUSIONS: Home-based administration of RRMS treatments (oral or SC) was associated with lower healthcare and non-healthcare costs compared to hospital-based IV therapies. Including overhead costs would likely widen this difference further. Administration costs should be considered alongside drug costs in cost-effectiveness analyses of RRMS therapies, as they may influence comparative value assessments.
METHODS: An observational study using a bottom-up micro-costing approach was conducted. Costs were categorized into: (i) direct healthcare costs, (ii) patient and family costs, and (iii) productivity losses. Patients received either nurse-administered ocrelizumab or natalizumab intravenously (IV) at the hospital, or self-administered cladribine (oral) or ofatumumab (subcutaneous; SC) at home. Healthcare resource use related to administration—such as staff time, consumables, and diagnostics—was recorded using case report forms. Patient questionnaires provided data on caregiver time, travel expenses, and productivity losses. Analyses followed Dutch health economic guidelines.
RESULTS: 121 RRMS patients were recruited from five treatment centers: 40 patients received ocrelizumab, 33 natalizumab, 7 cladribine, and 41 ofatumumab. Administration-related healthcare costs were highest for hospital-based IV ocrelizumab (mean €103) and lowest for home-based oral cladribine (€7). Non-healthcare costs —comprising productivity losses, informal care, and travel— were higher for hospital-based therapies, primarily due to productivity losses. Average total costs per administration were €275 (SD €170) for ocrelizumab, €139 (SD €116) for natalizumab, €13 (SD €15) for cladribine, and €23 (SD €61) for ofatumumab. Assuming annual dosing schedules of 2 administrations for ocrelizumab, 10 for natalizumab, 9 for cladribine (note: treatment is completed after two years), and 12 for ofatumumab, the corresponding annual administration costs were €549, €1.388, €115, and €279, respectively.
CONCLUSIONS: Home-based administration of RRMS treatments (oral or SC) was associated with lower healthcare and non-healthcare costs compared to hospital-based IV therapies. Including overhead costs would likely widen this difference further. Administration costs should be considered alongside drug costs in cost-effectiveness analyses of RRMS therapies, as they may influence comparative value assessments.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE578
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Health Technology Assessment
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Work & Home Productivity - Indirect Costs
Disease
Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)