OBJECTIVES : To evaluate the cost-effectiveness of alemtuzumab versus generic glatiramer acetate (GA) 20 mg in patients with relapsing multiple sclerosis (RMS) in the United States (US).

METHODS : A Markov model was developed from a US payer perspective with an annual cycle length and a time-horizon of 20 years. The modeled population represented pooled alemtuzumab-treated patients from the CARE-MS I (NCT00530348) and II (NCT00548405) trials. The British Columbia Multiple Sclerosis cohort data was used in the model to project the natural history of RMS disease progression. Treatment efficacy estimates for both therapies were derived from published network meta-analyses. Deterministic and probabilistic sensitivity analyses were conducted to assess any uncertainty in the model.

RESULTS : The base-case analysis results showed that over a 20-year time-horizon, alemtuzumab was less costly compared with generic GA 20 mg ($421,996 vs $895,661). Alemtuzumab-treated patients accumulated a higher number of quality-adjusted life-years (QALYs) compared with those on generic GA 20 mg (8.977 vs 7.845). In addition, patients on alemtuzumab had a lower total number of relapse events compared with patients on generic GA 20 mg (7.06 vs 9.79), irrespective of these relapses leading to hospitalization or not. The probabilistic sensitivity analysis confirmed the base-case results that alemtuzumab dominated generic GA 20 mg as patients accumulated lower total incremental costs (-$476,987; 95% CI: -$579,996 to -$379,029) and higher incremental QALYs (1.1379; 95% CI: 0.4230 to 1.8306). In a scenario where natural history data was sourced from the London Ontario dataset, alemtuzumab continued to be dominant (lower total incremental costs: -$212,222; 95% CI: -$260,900 to -$165,772, and higher incremental QALYs: 0.9442; 95% CI: 0.3635 to 1.5248).

CONCLUSIONS : Alemtuzumab is a cost-effective disease-modifying therapy for the treatment of patients with RMS when compared with generic GA 20 mg. These findings could help informed disease management decisions for effective RMS treatment.