OBJECTIVES: Cladribine is an EMA-approved therapy for multiple sclerosis which was recommended by NICE in the highly active RRMS (HA-RRMS) population in 2017. The aim of this budget impact analysis was to assess the potential economic impact of increasing uptake of cladribine vs. current usage of cladribine alongside other approved high-efficacy MS therapies in England and Wales.

METHODS: A budget impact model with a UK NHS perspective was developed to compare two scenarios: (1) Current market share of available therapies, including current usage of cladribine and (2) a future scenario with increased uptake of cladribine. The model assumed a 4-year time horizon. Drug acquisition costs as well as administration and monitoring costs were included. Drug acquisition costs were sourced from the British National Formulary (BNF). Administration and monitoring costs were obtained from NHS reference tariffs 2021/22. Dosing information was informed by product licenses and NICE recommendations. Market shares were based on company assumptions.

RESULTS: The model estimated 4,688 patients with HA-RRMS are treated per year in England and Wales. Increasing the current uptake of cladribine by 5% over a 4-year period is estimated to save the NHS a total of £5.7 million. Of the total cost savings, £2.6 million is attributed to lower drug acquisition costs and £3.1 million is attributed to reduced administration and monitoring costs of competitor therapies. This same increase in uptake of cladribine is also estimated to reduce the time associated with administration of competitor treatments in hospital by 10,779 hours as well as an estimated 4,546 less infusions administered.

CONCLUSIONS: Due to the unique dosing regimen and lower administration and monitoring requirements for cladribine, increasing uptake of cladribine is estimated to result in budget savings to the NHS, both in terms of drug acquisitions costs and healthcare resource use compared to established and newly approved therapies in HA-RRMS.