OBJECTIVES: Multiple Sclerosis (MS) treatment paradigm has been challenged with the approval of high efficacy treatments (HET). There is increasing evidence that starting with HET early in the disease course can result in better long-term outcomes compared to escalation approach. Our objective is to estimate the economic impact of an early use of Ofatumumab (HET), compared to long term usage of moderate disease modifying therapies (DMT), in adult MS patients with active disease.

METHODS: A cost-consequence analysis was performed using Markov state transition model, that simulated disease progression measured by Expanded Disability Status Scale (EDSS). Patients were assumed to remain on treatment until progression to EDSS 7. Efficacy, safety and health-state utility values were estimated from the ASCLEPIOS I/ II trials and network meta-analysis. Natural history was based on British Columbia MS registry and London Ontario database. Resource consumption was based on published literature, national microdata and expert opinion; unit costs were from official sources. Four scenarios with a time horizon of 10 years were simulated: two base scenarios evaluated Ofatumumab versus Dimethyl Fumarate (DMF) or Teriflunomide (standard DMT) without any treatment switches, and late switch scenario after 3 years of DMF or Teriflunomide treatment.

RESULTS: In 10 years when Ofatumumab is initiated as first treatment option, 15.3% patients progressed to EDSS 7 or higher compared with 20.7% patients on DMF and 23.1% on Teriflunomide. Treatment switch after 3 years to Ofatumumab increases this rate to 18.1% in the scenario with DMF and 19.4% with Teriflunomide. Disease management cost for Ofatumumab when early started is 27.910€, for DMF 32.195€ and Teriflunomide 34.210€, representing a cost reduction in 10 years of 13% and 18%, respectively.

CONCLUSIONS: At the end of 10 years, the early use of Ofatumumab demonstrated better clinical outcomes versus a delayed approach, accompanied by cost savings, in the Portuguese setting.