CLINICAL AND ECONOMIC IMPACT OF CARDIOVASCULAR AND CEREBROVASCULAR COMORBIDITIES IN MENOPAUSAL WOMEN WITH RELAPSING-REMITTING MULTIPLE SCLEROSIS IN SPAIN
Author(s)
Adrian Ares Luque, MD1, Ángela Vidal-Jordana, MD2, Ana Cristina Bandrés, PharmD3, Juan José Tamarit, MD4, Bleric Alcalá, MSc5, Heidi de los Santos Real, PhD5, Yeray Granado, PharmD5, Miriam Prades6, Susana Aceituno Mata, MSc, PhD7, Mirian Álvarez-Payero, PharmD8, María Luisa Martín, PharmD9.
1Neurology Service, Complejo Asistencial Universitario de León, León, Spain, 2Neurology Department, Hospital de la Santa Creu i Sant Pau, IR Sant Pau, Barcelona, Spain, 3Coordinación del Uso Racional del Medicamento de Aragón, Zaragoza, Spain, 4Internal Medicine Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain, 5Merck S.L.U., Madrid, Spain, an affiliate of Merck KGaA, Madrid, Spain, 6Evidenze Health, Castellón, Spain, 7Antares Evidenze Health Consulting, Barcelona, Spain, 8Hospital Pharmacy Service, Hospital de Valdeorras, Barco de Valdeorras, Ourense, Spain, 9Hospital Pharmacy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
1Neurology Service, Complejo Asistencial Universitario de León, León, Spain, 2Neurology Department, Hospital de la Santa Creu i Sant Pau, IR Sant Pau, Barcelona, Spain, 3Coordinación del Uso Racional del Medicamento de Aragón, Zaragoza, Spain, 4Internal Medicine Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain, 5Merck S.L.U., Madrid, Spain, an affiliate of Merck KGaA, Madrid, Spain, 6Evidenze Health, Castellón, Spain, 7Antares Evidenze Health Consulting, Barcelona, Spain, 8Hospital Pharmacy Service, Hospital de Valdeorras, Barco de Valdeorras, Ourense, Spain, 9Hospital Pharmacy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
OBJECTIVES: Cardiovascular and cerebrovascular comorbidities in relapsing-remitting multiple sclerosis (RRMS) are associated with greater disability progression, with notable relevance in menopausal women. This study assessed the cost-consequence of high-efficacy disease-modifying therapies in this population of patients in Spain from a societal perspective.
METHODS: A 4-year prevalence-based model was developed to assess the cost-consequence of cladribine tablets (CladT), fingolimod, ponesimod, ozanimod, ocrelizumab, ofatumumab, and natalizumab in subpopulations of RRMS women aged 45-59 years with hyperlipidemia, ischemic cardiomyopathy, peripheral vascular disease (PVD), and cerebrovascular diseases. Subpopulations were estimated using the Spanish Primary Care Clinical Database. Disease disability progression was modelled based on the association between the presence of each comorbidity and the risk of disease progression. Direct (drug-cost, visits, tests, hospitalizations, informal care, and transportation), indirect (productivity losses), and intangible (quality-adjusted life year losses) costs related to disease progression were estimated (€, 2025). For each treatment and comorbidity, a cost-consequence analysis was performed considering treatment efficacy and persistence. Cost-consequence outcomes were expressed as the annual mean cost per disability progression-free patient. All inputs were sourced from official databases and literature and were validated by a multidisciplinary expert panel.
RESULTS: A population of 15,363 women with RRMS aged 45-59 years was estimated, with 4,035 hyperlipidemia, 78 ischemic cardiomyopathy, 2,041 PVD, and 153 cerebrovascular disease cases. In patients with hyperlipidemia, the annual mean cost per disability progression-free patient ranged from €51,028 (CladT) to €66,105 (ozanimod). In ischemic cardiomyopathy, it ranged from €70,542 (CladT) to €80,114 (ocrelizumab). In PVD, the results ranged from €60,666 (CladT) to €100,896 (ozanimod). In cerebrovascular comorbidities, it ranged from €112,228 (CladT) to €274,626 (ponesimod).
CONCLUSIONS: The presence of cardiovascular and cerebrovascular comorbidities in menopausal women with RRMS imposes substantial clinical and economic burden. In this context, CladT were identified as the most favourable cost-consequence balance treatment option.
METHODS: A 4-year prevalence-based model was developed to assess the cost-consequence of cladribine tablets (CladT), fingolimod, ponesimod, ozanimod, ocrelizumab, ofatumumab, and natalizumab in subpopulations of RRMS women aged 45-59 years with hyperlipidemia, ischemic cardiomyopathy, peripheral vascular disease (PVD), and cerebrovascular diseases. Subpopulations were estimated using the Spanish Primary Care Clinical Database. Disease disability progression was modelled based on the association between the presence of each comorbidity and the risk of disease progression. Direct (drug-cost, visits, tests, hospitalizations, informal care, and transportation), indirect (productivity losses), and intangible (quality-adjusted life year losses) costs related to disease progression were estimated (€, 2025). For each treatment and comorbidity, a cost-consequence analysis was performed considering treatment efficacy and persistence. Cost-consequence outcomes were expressed as the annual mean cost per disability progression-free patient. All inputs were sourced from official databases and literature and were validated by a multidisciplinary expert panel.
RESULTS: A population of 15,363 women with RRMS aged 45-59 years was estimated, with 4,035 hyperlipidemia, 78 ischemic cardiomyopathy, 2,041 PVD, and 153 cerebrovascular disease cases. In patients with hyperlipidemia, the annual mean cost per disability progression-free patient ranged from €51,028 (CladT) to €66,105 (ozanimod). In ischemic cardiomyopathy, it ranged from €70,542 (CladT) to €80,114 (ocrelizumab). In PVD, the results ranged from €60,666 (CladT) to €100,896 (ozanimod). In cerebrovascular comorbidities, it ranged from €112,228 (CladT) to €274,626 (ponesimod).
CONCLUSIONS: The presence of cardiovascular and cerebrovascular comorbidities in menopausal women with RRMS imposes substantial clinical and economic burden. In this context, CladT were identified as the most favourable cost-consequence balance treatment option.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE200
Topic
Economic Evaluation
Disease
Neurological Disorders