VALUE OF CLADRIBINE TABLETS TREATMENT PERSISTENCE IN RELAPSING-REMITTING MULTIPLE SCLEROSIS: QUANTIFYING THE ECONOMIC IMPACT FROM THE SPANISH HEALTHCARE SYSTEM PERSPECTIVE
Author(s)
Joaquin Borrás Blasco, MD1, Bleric Alcalá, MSc2, Heidi de los Santos Real, PhD2, Yeray Granado, PharmD2, Daniel López-Bernal, MSc3, Maria Soler, MSc3, Susana Sainz de la Maza, MD4.
1Hospital de Sagunto, Valencia, Spain, 2Merck S.L.U., Madrid, Spain, an affiliate of Merck KGaA, Darmstadt, Germany, Madrid, Spain, 3Outcomes'10 a Product Life Group company, Castellón, Spain, 4Hospital Ramón y Cajal, Madrid, Spain.
1Hospital de Sagunto, Valencia, Spain, 2Merck S.L.U., Madrid, Spain, an affiliate of Merck KGaA, Darmstadt, Germany, Madrid, Spain, 3Outcomes'10 a Product Life Group company, Castellón, Spain, 4Hospital Ramón y Cajal, Madrid, Spain.
OBJECTIVES: To estimate pharmacological cost implications of real-world persistence with CladT in relapsing-remitting multiple sclerosis from the Spanish NHS perspective.
Although observational studies of cladribine tablets (CladT) provide real-world evidence beyond trials, data on treatment persistence remains limited. Assessing persistence in routine clinical practice is important to understand its potential consequences for healthcare resource use and costs.
METHODS: A six-year simulated model followed annual cohorts of 100 patients (600 total) initiating CladT each year. Costs were estimated by treatment persistence, using public prices, Summary of Product Characteristics dosing, and tablets required for a 70 kg patient. The model included weighted annual costs of subsequent therapies and additional CladT courses. Persistence indicated completing year 1 and 2 dosing without switching. Non-persistence was failure to complete both courses or switching, assumed after 6 months on average, to another disease-modifying therapy. The base case used MSBase registry real-world data (n=3,834 RRMS patients treated with CladT since 2017) for persistence, annual switching (4.82%), and additional CladT-course use. The CLARENCE study (n>1,900 relapsing MS patients receiving CladT) informed post-switch treatment distribution and switch timing. Alternative scenarios used real-world studies.
RESULTS: In year 6, 527 of 600 patients remained on therapy, corresponding to 87.83% of the accumulated treated population. Mean annual pharmacological cost per patient decreased from €25,197 (range: €24,204-€26,189) in year 1 to €10,572 (range: €10,391-€10,752) in year 6, a 58% modelled reduction. This was driven by the absence of scheduled treatment after the initial cycles and limited switching or additional treatment. Scenario analyses using 4-year persistence estimates from Finland (70%) and Southeast Europe (67.7%) showed 55% and 49% reductions, respectively; results were sensitive to switch patterns and subsequent-therapy costs.
CONCLUSIONS: High persistence with CladT may be associated with lower mean annual pharmacological costs over six years in the Spanish NHS, potentially enabling resource reallocation to treat more patients.
Although observational studies of cladribine tablets (CladT) provide real-world evidence beyond trials, data on treatment persistence remains limited. Assessing persistence in routine clinical practice is important to understand its potential consequences for healthcare resource use and costs.
METHODS: A six-year simulated model followed annual cohorts of 100 patients (600 total) initiating CladT each year. Costs were estimated by treatment persistence, using public prices, Summary of Product Characteristics dosing, and tablets required for a 70 kg patient. The model included weighted annual costs of subsequent therapies and additional CladT courses. Persistence indicated completing year 1 and 2 dosing without switching. Non-persistence was failure to complete both courses or switching, assumed after 6 months on average, to another disease-modifying therapy. The base case used MSBase registry real-world data (n=3,834 RRMS patients treated with CladT since 2017) for persistence, annual switching (4.82%), and additional CladT-course use. The CLARENCE study (n>1,900 relapsing MS patients receiving CladT) informed post-switch treatment distribution and switch timing. Alternative scenarios used real-world studies.
RESULTS: In year 6, 527 of 600 patients remained on therapy, corresponding to 87.83% of the accumulated treated population. Mean annual pharmacological cost per patient decreased from €25,197 (range: €24,204-€26,189) in year 1 to €10,572 (range: €10,391-€10,752) in year 6, a 58% modelled reduction. This was driven by the absence of scheduled treatment after the initial cycles and limited switching or additional treatment. Scenario analyses using 4-year persistence estimates from Finland (70%) and Southeast Europe (67.7%) showed 55% and 49% reductions, respectively; results were sensitive to switch patterns and subsequent-therapy costs.
CONCLUSIONS: High persistence with CladT may be associated with lower mean annual pharmacological costs over six years in the Spanish NHS, potentially enabling resource reallocation to treat more patients.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE61
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas