OBJECTIVES: To evaluate the cost-effectiveness of ocrelizumab versus fingolimod, natalizumab and dimethyl fumarate for the treatment of adult patients with relapsing-remitting multiple sclerosis (RRMS) in Greece.

METHODS: An international Markov model with one-year cycle was locally adapted from a third-party public payer perspective to reflect the natural progression of adult patients with RRMS through different health states based on the Kurtzke expanded disability status scale (EDSS) over a life-time horizon (63 years). Clinical data and utilities were extracted from relevant clinical trials and a network meta-analysis comparing the effectiveness of ocrelizumab and the other three therapeutic alternatives. Direct medical costs (prices €, 2018) included drug acquisition & administration, disease management per EDSS state, relapse management, adverse events management and patient monitoring. Outcomes were evaluated in terms of per patient total therapy cost, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) per QALY gained. Both costs and outcomes were discounted at 3.5% per annum and a probabilistic sensitivity analysis (PSA) was conducted.

RESULTS: The total lifetime cost per patient with ocrelizumab, fingolimod, natalizumab and dimethyl fumarate was estimated at €210,908, €181,608, €195,808, and €145,087 respectively. Ocrelizumab was associated with 1.35, 0.56 and 1.14 incremental gain in QALYs, resulting into ICERs of €21,760, €27,116 and €57,521 per QALY gained versus fingolimod, natalizumab and dimethyl fumarate respectively. PSA confirmed the deterministic results.

CONCLUSIONS: Results suggest that ocrelizumab provides substantial health gains in QALYs compared to other disease-modifying therapies at a reasonable cost. Hence, ocrelizumab appears to be a cost-effective treatment option compared to fingolimod and natalizumab and a good value for money option versus dimethyl fumarate for the treatment of patients with RRMS in Greece.