Presentation (CTI)

OBJECTIVES: Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing autoimmune disease associated with substantial disability and economic burden in China. Since no head-to-head trials compare biologics, this study evaluated lifetime cost-utility of obinutuzumab beta versus inebilizumab and satralizumab from healthcare system and societal perspectives.
METHODS: A lifetime Markov model (36-year horizon; 1-month cycles; starting age 43 years) simulated transitions among no/minimal disability (Expanded Disability Status Scale [EDSS] <6), disability (EDSS ≥6), and death. Efficacy inputs came from three placebo-controlled phase III trials. Since each biologic was evaluated in a single trial versus placebo, relative effects versus placebo (hazard ratios and annualized relapse rate ratios) were applied to a common placebo annualized relapse rate from the obinutuzumab beta trial in an meta-analysis to estimate treatment-specific relapse rates. Direct medical costs used Chinese prices and published resource use; societal analyses incorporated productivity and caregiving losses. Health-state utilities and relapse disutilities were obtained from NMOSD clinical and economic literature.
RESULTS: Obinutuzumab beta dominated both comparators in base-case analyses. From the healthcare perspective, lifetime costs were CNY 528,546 versus CNY 2,124,302 (inebilizumab) and CNY 1,974,066 (satralizumab); QALYs were 13.17 versus 13.00 (inebilizumab) and 13.00 (satralizumab), yielding negative incremental cost-effectiveness ratios (ICERs). Societal costs were CNY 991,693 versus CNY 2,587,775 and CNY 2,438,242. Anchored indirect comparison estimated 52-week annualized relapse rates of 0.028, 0.171, and 0.104 for obinutuzumab beta, inebilizumab, and satralizumab, respectively. Sensitivity analyses indicated findings were most sensitive to comparator relapse rates, drug prices, and utilities but remained dominant.
CONCLUSIONS: In the absence of direct comparative evidence, placebo-anchored meta-analysis linked to a China-specific Markov model suggests obinutuzumab beta may provide greater QALYs at lower lifetime costs than inebilizumab or satralizumab for NMOSD under both perspectives. Results may inform health technology assessment, although uncertainty related to transitivity and indirect comparison assumptions should be acknowledged.