OBJECTIVES: Multiple Sclerosis (MS) is a neurological disease affecting mainly the young and middle-aged population at their most productive ages. The objective of this study is to evaluate the cost-effectiveness of ofatumumab against ocrelizumab and natalizumab for the treatment of Relapsing MS (RMS).

METHODS: A discrete time, cohort Markov model based on 10 EDSS scores was constructed. EDDS health states determined the HRQoL, costs, relapses and mortality rates. The model population was aligned to the population in ASCLEPIOS I & II trials. A network meta-analysis was conducted as there is no direct comparison trial with ofatumumab and comparators. The key clinical outcomes were time to 3 and 6 months confirmed disability, worsening on EDSS and annualized relapse rates. Only direct costs were included in the model as per the requirements of the Social Security Institution (SSI). Costs were estimated based on expert views of resources used for each EDSS state, adverse event and relapse. Both costs and outcomes were discounted by 3%. ICER was calculated as the incremental cost per incremental life years (LY) as required by the SSI.

RESULTS: Ofatumumab was dominant in its comparison with natalizumab and provided same duration of life years (23.07) with lower costs (2,722,059 TRY vs 3,086,947 TRY). The ICER was 51,368 TRY for the comparison between ofatumumab and ocrelizumab. Both products provided same life years (23.07) with incremental cost of 51.368TRY (2,722,059 TRY vs. 2,670,690). Sensitivity analyses indicated that the results were robust.

CONCLUSIONS: Turkey does not have a threshold to be used in decision-making. Ofatumumab dominated natalizumab in the cost-effectiveness analysis. The ICER for ofatumumab vs ocrelizumab was lower than the GDP per capita. It can be concluded that ofatumumab is a cost-effective option in treatment of RMS in Turkey.