OBJECTIVES: To evaluate the cost-effectiveness of alemtuzumab compared to other disease modifying treatment options for patients with relapsing-remitting multiple sclerosis (RRMS) from a third-party payer perspective in Cyprus.

METHODS: The analysis is based on a Markov model that predicts the costs and outcomes of a cohort of patients with RRMS under different disease-modifying agents. Baseline characteristics of the model population reflect those of the sample of the CARE-MS studies. RRMS patients with active disease who were either naïve or pretreated and had Expanded Disability Status Scale scores from 0-5 enter the model. Transition probabilities through health states are dependent on the efficacy of each treatment and are sourced by a network meta-analysis. Costs reflect those of the third-party payer in Cyprus for the year 2017, based on official price lists. Resource consumption was estimated by a panel of experts and utilities were sourced from the literature.

RESULTS: The cost for treatment with alemtuzumab over a lifetime horizon was €251,698, whereas the respective cost of its comparators ranged from €208,306 with interferon beta-1a to €306,024 with natalizumab. Alemtuzumab was accompanied by favorable cost-effectiveness ratios. It dominated when compared with natalizumab and fingolimod demonstrating higher efficacy (gains of 1.35 and 2.00 QALYs compared to natalizumab and fingolimod, respectively) at lower costs (cost of €306.024 and €299.415 for natalizumab and fingolimod, respectively). When compared to interferon beta-1a, alemtuzumab gave rise to an incremental cost effectiveness ratio (ICER) of €19.042 per QALY, while resulting in gains of 2.28 QALYs. The results remained favorable over a series of deterministic sensitivity analyses.

CONCLUSIONS: Alemtuzumab has demonstrated dominance over natalizumab and fingolimod due to higher efficacy at lower costs, as a treatment option for patients with RRMS in Cyprus. It demonstrated significantly higher efficiency at a higher cost versus interferon beta-1a, resulting in an ICER below the accepted willingness-to-pay threshold.