OBJECTIVES: Multiple sclerosis is the most-frequent cause of non-traumatic neurologic disability in young adults. In Italy, there are approximately 114,000 affected patients, with over 3,400 new diagnoses annually. The aim of this research was to assess the cost-effectiveness of alemtuzumab in comparison with other disease modifying therapies (DMTs) in the management of relapsing-remitting multiple sclerosis (RRMS) from the payer perspective in Italy.

METHODS: A Markov model was used to assess cost-effectiveness of alemtuzumab in comparison with subcutaneous IFN β-1a, comparator in clinical development program CARE-MS, natalizumab, and fingolimod in the RRMS population. Treatment effects were derived from a network meta-analysis (NMA). Economic input included cost of therapies and their follow-up, cost of adverse events, and cost of relapse. Data on the utilisation of health resources and their costs were retrieved from published sources. Health effects were expressed as quality adjusted life years (QALY) while costs were expressed in monetary units (€, 2017). Cost-effectiveness was measured as incremental cost per QALY, also the robustness of the results was demonstrated with an univariate and probabilistic sensitivity analyses.

RESULTS: Over a lifetime horizon, alemtuzumab yielded more QALYs and less costs in comparison with the other DMTs. Treatment with alemtuzumab in RRMS patients yielded an incremental benefit of 1.62, 1.03 and 1.36 with savings of €4,312, €81,562 and €54,067 versus IFN 1β 1a, fingolimod and natalizumab, respectively. Results suggest the incremental cost per QALY for alemtuzumab vs IFNB-β-1a carries a 70% likelihood of being below the accepted threshold (€40,000), while the likelihood rises to 90% and 85% in comparison to fingolimod and natalizumab, respectively.

CONCLUSIONS: Based on the current analysis, alemtuzumab is likely to be dominant (i.e., less costly and more effective) vs. IFNB-β-1a, natalizumab and fingolimod in the treatment for RRMS patients in Italy.