OBJECTIVES: The aim of this study is to compare cost utility of Ocrelizimuab versus Fingolimod in relapsing-remitting multiple sclerosis (RRMS) from Ministry of Health payor perspective in Egypt.

METHODS: A lifetime Markov model was developed with a cycle length of one year. Each health state in the model is associated with a utility and a cost and both are discounted with a 3.5% rate according to Egyptian guidelines. Clinical inputs were driven from the network meta-analysis (NMA), the two main clinical findings over which the health states were chosen are the occurrence of relapses and the disability progression over time. utility values for each health state were taken from published literature. Direct medical treatment costs were collected from MoH perspective.

RESULTS: Ocrelizumab led to an expected gain of 1.57 QALYs versus Fingolimod at an incremental cost of 156,509 EGP presenting an incremental cost-effectiveness ratio (ICER) of 99,656 EGP/QALY. The results of one way sensitivity analysis revealed that the key parameters with greatest impact on the ICER value are ocrelizumab annual cost followed by the discounting rate and From the cost-effectiveness acceptability curves (CEAC) it can be seen that at a willingness to pay off 145,000 EGP per QALY, the probability of ocrelizumab of being cost-effective is 98.6 % and the probability of fingolimod for being cost-effective at the same threshold is 1.40%.

CONCLUSIONS: Ocrelizumab is cost-effective versus Fingolimod in patients with RRMS from MoH perspective which is below the accepted willingness to pay threshold in Egypt which is 3 times GDP/CAPITA equivalent to 145,000 EGP/QALY.