OBJECTIVES

The aim of this work was to show the base case cost-effectiveness of ocrelizumab compared with fingolimod or dimethyl fumarate (DMF) for the second line treatment of highly active RRMS from payer perspective.

METHODS

A global cohort multi-state Markov cost-utility model reflecting health states based on disease classification and severity was developed. Two key clinical manifestations are reported in RRMS, an exacerbation of symptoms (known as relapses) and progressing disability over time based on EDSS. The probability of changing EDSS state (disability progression) or experiencing a relapse was determined by natural history data (underlying disease progression of patients not on therapy) as well as conversion from RRMS to SPMS. Treatments were assumed to delay the progression of disease and reduce the frequency of relapses in RRMS; by applying a treatment effect to natural history data. Treatment effects, annual relapse rate and confirmed disability progression were taken from NMA. Relevant hazard rates for target subgroup of pooled OPERA 1 & 2 cohorts were used in the model. Patient utility has been sourced from literature. Discount rates 3% for costs and outcomes, half cycle correction and model cycle length 1 year was applied. Treatment was discontinued from all-cause or if EDDS achieved 7.

RESULTS

Over a timeframe of 30 years, the average total cost of patient treatment with ocrelizumab was $239,264, with an average 1.13 QALY gained against fingolimod and 2.60 QALY gained against DMF. Compared to fingolimod, the incremental cost was $5,567, corresponding to ICER $4,928 per QALY. Compared to DMF, the incremental cost was $27,862, corresponding to ICER $10,742 per QALY.

CONCLUSIONS

Use of ocrelizumab is cost-effective for the second line treatment of highly active relapsing-remitting multiple sclerosis in a Czech public healthcare setting and resulted in greater QALY versus comparators in the base case.