OBJECTIVES: Nabiximols oromucosal spray (Sativex®), a complex botanical containing THC and CBD as well as other cannabinoid and non-cannabinoid components, was approved by Swissmedic in 2013 for treatment of moderate-to-severe spasticity due to multiple sclerosis (MS). We investigated cost-utility of nabiximols in Switzerland using the Markov model developed by Oppe et al. 2021 (DOI:10.1007/s10198-021-01285-1).

METHODS: The Markov model-based analysis uses a probabilistic bootstrapping sensitivity analysis approach to evaluate the cost–utility of nabiximols as an add-on therapy compared to standard-of-care (SoC) alone. Healthcare costs and quality adjusted-life years (QALY) were simulated in an Excel-based model including four health states. Three health states were related to spasticity severity and one to death over a five-year time horizon. Transition probabilities for spasticity severity were mainly based on the RCT SAVANT (EudraCT 2015-004451-40) comparing add-on therapy with nabiximols according to label with SoC alone. The 28-day model cycles matched study design. Transition probabilities for death were based on Swiss life tables. Health utility was informed by the quality of life data collected in SAVANT using the SF-36. Healthcare costs were based on published data on MS diagnosis and therapy in Switzerland and official Swiss national tariffs. Costs and effects were discounted by 3% per year.

RESULTS: After one year, nabiximols dominated SoC with per patient mean cost savings of CHF 41.54 and a QALY gain of 0.038. This dominance became more pronounced over time; in the fifth year the per patient mean cost savings were CHF 15,642.67 and a QALY gain of 0.169. The probability of dominance increased from 47% in the first year to 94% in the fifth year.

CONCLUSIONS: In the Swiss healthcare setting, treatment of moderate-to-severe spasticity due to MS with nabiximols according to the approved label was found to be cost-saving, providing QALY gains comparing to SoC alone.