OBJECTIVES: Caring for patients with relapsing multiple sclerosis (RMS) poses economic and humanistic burdens that are well-documented, but in the United States (US) are seldom incorporated into the cost-effectiveness appraisal of disease modifying treatments (DMTs). Alemtuzumab (ALEM) was compared to ocrelizumab (OCR) and natalizumab (NAT), accounting for societal spillover effects due to RMS treatment.

METHODS: A Markov model with annual cycles and 20-year time horizon was run separately from US payer and societal perspectives. The societal perspective analysis built upon the payer perspective by including productivity loss costs, informal care costs, and caregiver disutility. For ALEM, the population represented characteristics of pooled treatment-naive and non-naive patients from the CARE MS I and II trials (NCT00530348, NCT00548405). The British Columbia Multiple Sclerosis cohort was used to model the natural history of RMS disease progression. Network meta-analysis provided data on the relative efficacy of DMTs in reducing relapses and slowing disability. Withdrawal rates, treatment waning, resource use, costs and utility inputs were populated using published data and clinical expert opinion. Information on adverse events was derived from package inserts and published sources.

RESULTS: From US payer perspective, ALEM dominated comparators by accumulating more quality-adjusted life years (QALYs) and lower costs vs OCR (+0.499; -$486,368) and NAT (+0.516; -$626,578). The benefit of ALEM over comparators further increased when the analysis was conducted from the societal perspective vs OCR (+0.556; -$513,813) and vs NAT (+0.575; -$655,263). Sensitivity analyses identified the DMT withdrawal rate as one of the most influential model parameters.

CONCLUSIONS: The cost-effectiveness of ALEM was driven by its durable efficacy in the absence of continuous treatment and by savings from treatment acquisition costs over the time horizon. ALEM generated greater positive spillover effects to society by reducing caregiver disutility, informal care, and productivity loss versus comparators.

STUDY SUPPORT: Sanofi