Cost-effectiveness of cladribine tablets, alemtuzumab, and natalizumab in the treatment of relapsing-remitting multiple sclerosis with high disease activity in England

Hettle, Robert; Harty, Gerard; Wong, Schiffon L.

doi:10.1080/13696998.2018.1461630

Cited by 33 publications

(74 citation statements)

References 32 publications

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“…Cladribine tablets were also cost saving in all sensitivity analyses with a 4-year time horizon, even when assuming a sequential approach. These findings are supported by cost estimates from other settings [18][19][20]. The only exception was with the 3-year time horizon, in which fingolimod was €4580 less costly per patient and €1,282,280 less costly in the overall population compared to cladribine tablets.…”

Section: Discussionsupporting

confidence: 58%

“…In foreign settings and modelled comparisons, cladribine tablets have been observed to be dominant (i.e. lower cost and higher effectiveness) in various settings: compared to fingolimod in Spanish patients with highly active relapsing disease [18], compared to alemtuzumab and natalizumab in English patients with highly active RRMS [19], and compared to alemtuzumab and fingolimod in patients with highly active RRMS as well as compared to natalizumab in patients with rapidly evolving severe disease in the Dutch setting [20]. A cost assessment model (CAM) was developed to project the costs of DMDs for highly active disease in Finland.…”

Section: Introductionmentioning

confidence: 99%

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Cost Assessment Modelling of Treatments for Highly Active Relapsing Multiple Sclerosis

et al. 2019

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Introduction:Cost assessment modelling (CAM) of treatments in highly active relapsing multiple sclerosis was conducted. Methods: The CAM was developed using the R programming language. The PICOSTEPS health technology assessment framework was applied in the CAM. Modelled patients were 280 adults with highly active relapsing multiple sclerosis eligible for disease-modifying treatment. Intervention was cladribine tablets, a new and reimbursed oral treatment for highly active

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Section: Discussionsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Cost Assessment Modelling of Treatments for Highly Active Relapsing Multiple Sclerosis

et al. 2019

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“…This study used a cohort-based Markov model that compared the long-term effectiveness of DMDs to BSC in patients with RRMS. The model structure is similar to the one previously published by Hettle and colleagues, but Hettle et al focused more narrowly on the high disease activity (HDA) RRMS population 41 . This model structure was chosen because it incorporates different state structures, assumptions on waning effects, and multiple sub-populations of the RRMS population.…”

Section: Step 2 Modeled Long-term Disease Progression In Rrms Cohortmentioning

confidence: 91%

Modeling the impact of patient treatment preference on health outcomes in relapsing-remitting multiple sclerosis

Eijndhoven¹,

Brauer²,

Kee³

et al. 2020

Journal of Medical Economics

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Aims: Model how moving from current disease-modifying drug (DMD) prescribing patterns for relapsing-remitting multiple sclerosis (RRMS) observed in the United Kingdom (UK) to prescribing patterns based on patient preferences would impact health outcomes over time. Materials and methods: A cohort-based Markov model was used to measure the effect of DMDs on long-term health outcomes for individuals with RRMS. Data from a discrete choice experiment were used to estimate the market shares of DMDs based on patient preferences (i.e. preference shares). These preference shares and real-world UK market shares were used to calculate the effect of prescribing behavior on relapses, disability progression, and quality-adjusted life-years (QALYs). The incremental benefit of patient-centered prescribing over current practices for the UK RRMS population was then estimated; scenario and sensitivity analyses were also conducted. Results: Compared to current prescribing practices, when UK patients with RRMS were treated following patient preferences, health outcomes were improved. This population was expected to experience 501,690 relapses and gain 1,003,263 discounted QALYs over 50 years under patient-centered prescribing practices compared to 538,417 relapses and 958,792 discounted QALYs under current practices (À6.8% and þ4.6%, respectively). Additionally, less disability progression was observed when prescribed treatment was based on patient preferences. In a scenario analysis where only oral treatments were considered, the results were similar, although the magnitude of benefit was smaller. Number of relapses was most sensitive to how the annualized relapse rate was modeled; disability progression was most sensitive to mortality rate assumptions. Limitations: Treatment efficacy estimates applied to various models in this study were based on data derived from clinical trials, rather than real-world data; the impact of patient-centered prescribing on treatment adherence and/or switching was not modeled. Conclusions: The population of UK RRMS patients may experience overall health gains if patient preferences are better incorporated into prescribing practices.

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“…The analyses were conducted using an existing cohort-based Markov model that simulated the costs and effectiveness of RRMS treatment, following the structure used in previous economic models 19,20 .…”

Section: Model Structurementioning

confidence: 99%

“…Recently, Hettle et al 20 published a cost-effectiveness analysis comparing cladribine tablets with alemtuzumab and natalizumab in the treatment of relapsing-remitting multiple sclerosis with HDA in England. The authors found that cladribine tablets was a dominant alternative.…”

Section: Journal Of Medical Economicsmentioning

confidence: 99%

Cost-effectiveness of cladribine tablets versus fingolimod in patients with highly active relapsing multiple sclerosis in Portugal

Pinheiro

Guerreiro

Costa

et al. 2020

Journal of Medical Economics

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Aims: To assess the cost-utility of cladribine tablets versus fingolimod in patients with highly active relapsing-remitting multiple sclerosis (RRMS) in Portugal. Methods: A 1-year cycle cohort-based Markov state transition model was developed to simulate disease progression, measured by Kurtzke Expanded Disability Status Scale (EDSS), relapses, and conversion to secondary-progressive MS (SPMS). Patients were assumed to remain on treatment until progression to EDSS level 7, conversion to SPMS, or complete loss of efficacy due to waning effect. Natural history was based on British Columbia Multiple Sclerosis registry, London Ontario database, UK MS Trust, and cladribine tablets clinical trial (CLARITY). Portuguese all-cause mortality was adjusted for the MS associated increased mortality. Clinical inputs for active treatments (disability progression and relapse rate) were estimated on a network meta-analysis. Utility weights were derived from UK-MS Survey and published literature. Resource consumption by EDSS and due to relapses was based on published literature, National DRG microdata and expert opinion. Unit costs were obtained from official sources. The analysis was conducted from payers' perspective, time horizon of 50 years and discount rate of 5%, for both costs and benefits. Uncertainty was assessed via probabilistic and deterministic sensitivity analyses. Results: Compared to fingolimod, cladribine tablets were associated with a delay in progression, resulting in a gain of 0.85 quality adjusted life years (QALYs) and a cost decrease of 25,935 e. Probabilistic sensitivity analysis resulted in a mean ICER of À31,781 e per QALY and was dominant in 98.7% of the simulations. Cladribine tablets were dominant across the scenario analyses tested. Conclusions: Treatment of highly active RRMS with cladribine tablets was less costly and more effective than treatment with fingolimod. Hence, it is a dominant strategy in the Portuguese setting. No conclusions can be drawn from the present study regarding other treatment options, in particular natalizumab and alemtuzumab.

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Cost-effectiveness of cladribine tablets, alemtuzumab, and natalizumab in the treatment of relapsing-remitting multiple sclerosis with high disease activity in England

Abstract: Cladribine tablets are a cost-effective alternative to alemtuzumab and natalizumab in the treatment of HDA-RRMS from the perspective of the NHS in England.

Cited by 33 publications

References 32 publications

Cost Assessment Modelling of Treatments for Highly Active Relapsing Multiple Sclerosis

Cost Assessment Modelling of Treatments for Highly Active Relapsing Multiple Sclerosis

Modeling the impact of patient treatment preference on health outcomes in relapsing-remitting multiple sclerosis

Cost-effectiveness of cladribine tablets versus fingolimod in patients with highly active relapsing multiple sclerosis in Portugal

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