OBJECTIVES: the economic burden of multiple sclerosis (MS) therapies in low- and middle-income countries has been poorly studied; inclusion of disease modifying therapies (DMT) in socialized public medicine’s budget, must be analyzed in terms of how to improve the accessibility of drugs, with the highest efficacy, achieving a good balance in terms of health expenses. The objective of this study is to estimate the best balance of cost-effectiveness among patients treated with DMT in the Panamanian Social Security Institute (PSSI).

METHODS: a 48-month micro-simulation first-order model projecting clinical outcomes (progression and relapses) in MS treated patients and costs related to medical attention was developed from the perspective of the current PSSI Neurology Department MS guidelines of care (a 3% discount rate was applied), including approved DMT (Fingolimod, Cladribine, Natalizumab, Ocrelizumab and Alentuzumab). Target population included a sample of current treated MS patients (n=129), and inclusion of new cases was estimated as nearly 24 per year according to the PSSI-MS dataset. Annualized individual costs and 4-years budget impact analysis were also analyzed.

RESULTS: relapse-free rate (RFR) and 48 months total costs were better for Alentuzumab (81.7% and $120,112.21), Ocrelizumab (75.1% and $99,587.16) and Cladribine (74.3% and $85,594.22) respectively, with the best cost-effectiveness relationship. When adding the model for optimal combination in a 4-years budget impact analysis, total coverage increased to 65.1% of patients (129 cases to 213 cases from 2021 to 2024) with DMT, with a total budget impact of 33.7% ($5,626,546 to $5,626,546, from 2021 to 2024).

CONCLUSIONS: Alentuzumab, Cladribine and Ocrelizumab presented with the highest potential of saving expenses with the highest efficacy balance (less than 1% of increase in total budget after a 4-years projection, according to the best fit model) with all included DMT in a public health neurology department from the PSSI.