OBJECTIVES

Limited licensed treatments, and the insidious transition from relapsing-remitting multiple sclerosis (RRMS), have often delayed identification of the transition point to secondary progressive multiple sclerosis (SPMS). Therefore, despite the paucity of clinical evidence for efficacy, disease-modifying therapies (DMTs) licensed for RRMS are frequently continued into the early stages of SPMS. The cost-effectiveness of oral siponimod, an active SPMS DMT, versus continued oral or infused RRMS DMTs for patients with active SPMS, was evaluated.

METHODS

A cohort Markov model based on disease progression through Expanded Disability Status Scale health states, with annual cycles and lifetime horizon, was employed to determine the cost-effectiveness of siponimod from a National Health Service perspective for patients with active SPMS. Relapses were modelled as events and all DMTs were modelled at list price. Baseline characteristics, health state utility values, hazard ratios for 6-month confirmed disability progression, annualized relapse rate ratios and adverse events for siponimod were sourced from the phase 3 EXPAND clinical trial, supplemented by published literature. Costs, resource use data and comparator efficacy data were obtained from the literature and, in the absence of data, reasonable assumptions were made.

RESULTS

Quality-adjusted life years (QALYs) were greater for siponimod versus all comparators (3.44 versus 2.69–2.83). Incremental cost-effectiveness ratios (ICERs), calculated as cost (GBP) per QALY, for siponimod versus natalizumab (dominant), ocrelizumab (£4,859), fingolimod (£11,199) and dimethyl fumarate (£17,282) indicated that siponimod was cost-effective at accepted willingness-to-pay thresholds of £20,000–£30,000/QALY. Siponimod was not found to be cost-effective versus teriflunomide (£35,514) despite greater QALYs; a modest single-digit discount would be required for siponimod to be cost-effective versus teriflunomide at list price.

CONCLUSIONS

Earlier recognition of active SPMS, and treatment with siponimod – a clinically effective DMT licensed for active SPMS – offers a cost-effective treatment approach compared with continued use of oral or infused RRMS DMTs.