Wernicke's encephalopathy (WE) is a serious neurologic condition resulting from thiamine deficiency. The majority of cases involve alcoholism; however, nonalcohol-associated WE does occur and is under-recognized. We discuss a case of a 22-year-old man with a history of Crohn's disease who presented to our emergency department with multiple neurologic complaints related to WE. RÉSUMÉ L'encéphalopathie de Wernicke (EW) est une affection neurologique grave, qui résulte d'une carence en thiamine. Dans la majorité des cas, la maladie est associée à l'alcoolisme, mais il arrive qu'elle ne le soit, et, dans ces cas, l'affection est mal reconnue. Sera exposé ici le cas d'un jeune homme de 22 ans, qui avait des antécédents de maladie de Crohn et qui a consulté au service des urgences pour de nombreux troubles neurologiques liés à l'EW.

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Background Ofatumumab is a high-efficacy disease-modifying therapy (DMT) approved for first-line treatment of relapsingremitting multiple sclerosis (RRMS) in Canada.Objective The aim of this study was to evaluate the cost effectiveness of ofatumumab from a Canadian healthcare system perspective. Methods A Markov cohort model was run over 65 years using annual cycles, 1.5% annual discount rate, and 100% treatment discontinuation at 10 years. The British Columbia database informed natural history transition probabilities. Treatment efficacy for DMTs were sourced from a network meta-analysis. Clinical trial data were used to estimate probabilities for treatment-related adverse events. Health utilities and costs were obtained from Canadian sources (if available) and the literature. Results Among first-line indicated therapies for RRMS, ofatumumab was dominant (more effective, lower costs) over teriflunomide, interferons, dimethyl fumarate, and ocrelizumab. Compared with glatiramer acetate and best supportive care, ofatumumab resulted in incremental cost-effectiveness ratios (ICERs) of $24,189 Canadian dollars per quality-adjusted life-year (QALY) and $28,014/QALY, respectively. At a willingness-to-pay threshold of $50,000/QALY, ofatumumab had a 64.3% probability of being cost effective. Among second-line therapies (scenario analysis), ofatumumab dominated natalizumab and fingolimod and resulted in an ICER of $50,969 versus cladribine. Conclusions Ofatumumab is cost effective against all comparators and dominant against all currently approved and reimbursed first-line DMTs for RRMS, except glatiramer acetate.

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