INTRODUCTION

Multiple sclerosis (MS), a chronic neurological disorder, causes demyelination of spinal cord and brain cells resulting in progressive disability. Relapsing MS (RMS) patients with frequent relapses are classified as High Disease Activity (HDA) patients. Most of the currently available HDA-RMS treatments in Lebanon involve long-term administration and/or monitoring costs. Cladribine Tablets is a short-course oral treatment for HDA-RMS with favourable benefit-risk profile and includes a maximum 20 days of treatment over 2-years.

OBJECTIVES

: To assess the cost-utility and budgetary impact of introducing Cladribine Tablets compared to other disease-modifying therapies for treating HDA-RMS in Lebanon.

METHODS

: Microsoft Excel^® based cost-utility and budget-impact models were adapted from the Lebanese National Social Security Fund perspective. The inputs for adaptation were retrieved from literature and validated by MS experts in Lebanon. A sensitivity analysis was performed to assess the uncertainty in the analysis.

RESULTS

: The cost-utility analysis results demonstrated that Cladribine Tablets was dominant (i.e., less costly and more effective) versus alemtuzumab, fingolimod, and natalizumab. The cost saving was driven by drug acquisition, administration and monitoring costs, while incremental quality-adjusted life year (QALY) gain was driven by differences in delayed Expanded Disability Status Scale progression. Sensitivity analysis showed that Cladribine Tablets has a high probability (99.3-100%) of being dominant at a threshold of 22,000 United State Dollar per QALY gained. The budget impact analysis showed that the introduction of Cladribine Tablets would result in 5.0% (in partial displacement scenario) to 21.5% (in total displacement scenario) savings in the overall budget over five years.

CONCLUSIONS

: Cladribine Tablets is an effective and budget saving treatment option for the treatment of HDA-RMS patients in Lebanon from the NSSF perspective. This study could act as evidence for policymakers, budget holders and health advisors to build informed decisions for treatment coverage in Lebanon.