OBJECTIVES: To assess the cost-effectiveness of teriflunomide (TERI) compared to alternative disease-modifying therapies (DMTs) for the treatment of relapsing-remitting multiple sclerosis (RRMS) in Greece.

METHODS: A Markov model was used to access cost-effectiveness of TERI compared to peginterferon beta-1a (PEG-INF), interferon-beta-1b 250 µg (INF-b) dimethyl fumarate (DMF), fingolimod (FIN), glatiramer acetate (GA), interferon-beta-1a 30 µg (INF-1a-30) interferon-beta-1a 22 µg (INF-1a-22) and 44 µg (INF-1a-44) in RRMS patients from a third-party payer perspective over a lifetime horizon.Efficacy, safety data, and utility values were extracted from published studies. The direct medical costs (€2017) considered in the model includes drug acquisition and administration, disease management per EDSS state, relapse management, adverse events management, and monitoring of patients. Primary outcomes were patient quality-adjusted life years (QALYs) and incremental cost per QALY gained (ICER).Costs and outcomes were discounted at 3.5% per annum.A probabilistic sensitivity analysis was conducted.

RESULTS: Over a lifetime horizon, the total cost for TERI was €100,668 and for comparators ranged from €91,163 (PEG-INF) to €141,094 (FIN). In terms of health outcomes, TERI gained 6.48 QALYs, while, QALYs for comparators ranging from 6.12 (INF-1b) to 6.56 (DMF). The incremental analysis showed that TERI dominates INF-1a-22 and was a cost-effective option over INF-1a-44 (ICER: €44,395), IFN-1a-30 (ICER: €20,847), INF-1b (ICER: €8,246), and GA (ICER: €16,930) under the threshold of €51,000 per QALY gained. TERI was a more expensive treatment option compared to PEG-INF (€9,505) and cost-saving option over FIN (-€40,426) while these three treatment options were similar in terms of QALYs. Compared to DMF, teriflunomide was associated with lower total costs and marginally lower QALYs, resulting in an ICER of €127,322.A probabilistic sensitivity analysis confirmed the deterministic results.

CONCLUSIONS: The analysis suggests that TERI was estimated to be a cost-effective option compared to alternative DMTs in the treatment of adult patients with RRMS in Greece.