OBJECTIVES: Number-needed-to-treat (NNT) and cost data were combined to assess the cost-effectiveness of branded disease-modifying therapies (DMTs) for relapsing multiple sclerosis (RMS), and compare the incremental healthcare costs per relapse avoided and healthcare cost savings of ozanimod with commonly used oral and injectable DMTs.

METHODS: Comparative annualized relapse rate (ARR) and safety data were obtained from a network meta-analysis (NMA) of clinical trials of RRMS treatments identified in a systematic literature review, including ozanimod, fingolimod, dimethyl fumarate, teriflunomide, interferon beta-1a (Avonex and Rebif), glatiramer acetate, and interferon beta-1b (Betaseron). ARR-related NNTs relative to placebo and annual total healthcare costs were used to estimate the incremental annual cost per relapse avoided of each DMT vs. ozanimod. ARR, adverse event (AE) and serious AE (SAE) comparative data were combined with drug costs and with healthcare costs to manage relapses, AEs and SAEs, to estimate annual cost savings for ozanimod vs. other DMTs assuming a fixed treatment budget of one million USD.

RESULTS: Compared to DMTs considered, treatment with ozanimod was associated with lower incremental annual costs to avoid a relapse, ranging from $823,168 compared to Avonex to $72,789 compared to Gilenya. For all DMTs, except Betaseron, treatment with Zeposia was associated with overall healthcare cost savings, ranging from $38,283 in savings (vs. Rebif) to $427 in additional costs (vs. Betaseron) per one million dollars budget. Compared to oral DMTs, Zeposia was associated with an annual cost savings of $9,740 (Aubagio 7mg), $7,889 (Aubagio 14mg), $3,687 (Gilenya ) and $1,934 (Tecfidera).

CONCLUSIONS: Compared to DMTs considered, treatment with ozanimod was associated with substantial reductions in costs to avoid relapses. In fixed budget analysis, Ozanimod demonstrated a favourable annual cost-effective profile relative to other DMTs, except Betaseron, when accounting for relative treatment efficacy and safety, and drug and healthcare costs, leading to cost offsets when treating RMS patients.