OBJECTIVES

Relapsing Remitting Multiple sclerosis (RRMS) is a leading cause of neurological disability in young and middle-aged adults, affecting 2:1 to 3:1 more females than men. There are at least 15 disease-modifying drugs (DMDs) available, whose use is guided by clinical algorithms or disease activity. Recently, treatments specific for high disease activity (HDA) have been compared based on their clinical effectiveness, safety, quality of life (QoL) and cost. This study compared the cost-effectiveness of cladribine tablets versus four other high-efficacy treatments available in Colombia.

METHODS

A validated Markov Model of 11 health states (1 death and 10 by EDSS) accepted by NICE, was adapted to compare cladribine tablets to fingolimod, natalizumab, alemtuzumab and ocrelizumab from a third payer perspective. A population with RRMS above 18 years old with HDA, treatment cost and Quality Adjusted Lived Years (QALYs) was evaluated through annual cycles leading to relapse, death, discontinuation or disease progression for a 20-year horizon. Efficacy assumptions remained equal for all interventions throughout the horizon. Risk estimates and utilities were obtained from a network meta-analysis including all comparators. Data on direct costs of treatment (acquisition, administration, monitoring, adverse events, relapses) per EDSS state were obtained from local sources and experts. In the base case a discount rate for costs and outcomes of 5% was modeled. Through univariate and probabilistic analyses, the impact of model parameters on outcomes and uncertainty were estimated.

RESULTS

Cladribine tablets was dominant against alemtuzumab, fingolimod and natalizumab for a 20-year horizon. This is maintained at different discount rates (0, 3.5, 7%) of cost and outcomes and a 50-year horizon in more than 95% of simulations. The main difference in costs and QALYs is against natalizumab and fingolimod.

CONCLUSIONS

Cladribine tablets is a cost-effective treatment option for HDA-RRMS, when compared to alemtuzumab, natalizumab and fingolimod from a third payer perspective in Colombia.