OBJECTIVES: To evaluate the economic impact in Europe (Sweden, France, Germany, UK, Spain, and Italy) of beginning and continuing treatment with dimethyl fumarate (DMF) versus initiating treatment with glatiramer acetate (GA) and switching to DMF after treatment failure.

METHODS: A Markov model with 10 health states (EDSS scores from 0 to 9) and death over a lifetime horizon in MS patients using annual cycles was used to compare the outcomes of treated RRMS patients from a societal perspective. The model incorporates the ability to fail GA and switch to DMF based on incurring ≥ 2 relapses within a 12-month period. Efficacy inputs were estimated from a mixed treatment comparison, including hazard ratios for 6-month confirmed disability progression, and risk ratios for annualized relapse rates. Economic inputs included the costs of treatment, relapse, and disability status. All estimates reflect costs in 2018 Krona (Sweden), Euros (France, Germany, Italy, Spain) and British Pounds (UK).

RESULTS: Among RRMS patients initially treated with DMF in Sweden, Germany, France, and Italy, cost offsets were observed in the amount of kr385,356 for Sweden, €9,910 for France, €46,414 for Germany, and €825 for Italy. In addition, initiating DMF reduced relapses by 2.3 to 2.4, increased the time spent within EDSS states < 6 by ~1 year, and resulted in a 0.48 to 0.68 gain in quality-adjusted life years (QALYs). Cost increases were observed for Spain (€7,442) and the UK (£56,949). Despite increased costs, a reduction of 2.1 to 2.3 relapses, 0.75 to 0.92 year increase in the time spent with EDSS < 6, and 0.48 to 0.50 gain in QALYs, were observed per patient for Spain and UK.

CONCLUSIONS: DMF as the initial treatment for RRMS patients before initiating and failing on GA results in improved clinical benefits across all European countries with the majority demonstrating economic savings.

Supported by: Biogen