Cost-effectiveness of oral agents in relapsing-remitting multiple sclerosis compared to interferon-based therapy in Saudi Arabia

Abstract

BACKGROUNDPromising clinical and humanistic outcomes are associated with the use of new oral agents in the treatment of relapsing-remitting multiple sclerosis (RRMS). This is the first cost-effectiveness study comparing these medications in Saudi Arabia.OBJECTIVESWe aimed to compare the cost-effectiveness of fingolimod, teriflunomide, dimethyl fumarate, and interferon (IFN)-β1a products (Avonex and Rebif) as first-line therapies in the treatment of patients with RRMS from a Saudi payer perspective.DESIGNCohort Simulation Model (Markov Model).SETTINGTertiary care hospital.METHODSA hypothetical cohort of 1000 RRMS Saudi patients was assumed to enter a Markov model model with a time horizon of 20 years and an annual cycle length. The model was developed based on an expanded disability status scale (EDSS) to evaluate the cost-effectiveness of the five disease-modifying drugs (DMDs) from a healthcare system perspective. Data on EDSS progression and relapse rates were obtained from the literature; cost data were obtained from King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. Results were expressed as incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMB) in Saudi Riyals and converted to equivalent $US. The base-case willingness-to-pay (WTP) threshold was assumed to be $100 000 (SAR375 000). One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to test the robustness of the model.MAIN OUTCOME MEASURESICERs and NMB.RESULTSThe base-case analysis results showed Rebif as the optimal therapy at a WTP threshold of $100 000. Avonex had the lowest ICER value of $337 282/QALY when compared to Rebif. One-way sensitivity analysis demonstrated that the results were sensitive to utility weights of health state three and four and the cost of Rebif.CONCLUSIONNone of the DMDs were found to be cost-effective in the treatment of RRMS at a WTP threshold of $100 000 in this analysis. The DMDs would only be cost-effective at a WTP above $300 000.LIMITATIONSThe current analysis did not reflect the Saudi population preference in valuation of health states and did not consider the societal perspective in terms of cost.

Evaluating quantity and quality of literature focusing on health economics and pharmacoeconomics in Gulf Cooperation Council countries

“…15,16,20,22,23,26,[31][32][33][34]44,49,55,56,62 Thirty seven studies were published in medical journals, [14][15][16][17][18][19][20][22][23][24][25][26][28][29][30][31][32][33]36,38,40,41,44,46,49,50,[52][53][54][55][56][57][58][59][60][61][62] 7 in non-medical journals …”

“…The earliest study was published in 1991 14 and the most recent study was published in December 2017. 62 The majority studies were published in 2016 [49][50][51][52][53][54][55][56] ( Figure 2).…”

“…The mean (SD) number of authors per study was 4.20 (2.97) (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], in 45 studies the main authors were residing in the same country of study [14][15][16][17][18][19][20][21][22][23][24]26,[28][29][30][31][32]61,62 and only in 4 studies the main authors were residing in countries outside the G.C.C. 25,27,35,60 ; these included Canada, 25 USA , 27 UK 35 and Poland.…”

Fatigue and Self-management among Multiple Sclerosis Patients

“…The MS prevalence in Saudi Arabia shows that there is increasing in MS rate from 8 to 40 cases per 100.000 of population, this increases may related to well diagnosis and improvement of treatment facilities [13,14]. Furthermore, [3] confirmed that the total number of cases in Saudi Arabia now will be 12,863 per 32 million individuals with mean age of 25 years old which reported by the United Nations, which proves that Saudi Arabia now in the moderate to high risk zone.…”

“…The direct medical costs of MS in the United State are estimated of 10$ billion per year, and the indirect costs remains higher costs through reduced employment or unemployment, need for assistive equipment, paid personal care and productivity loss on later MS progression [2]. According to [3] who reported that in Saud Arabia, each neurology clinic visit for each MS patients coast around 820 Saudi Riyal from the stage of diagnosis to stage of receive require care in the last six years at King Faisal Specialist Hospital & Research Center.…”