Economic evaluation of cladribine tablets in high disease activity (HDA) relapsing multiple sclerosis (RMS) patients in Lebanon

Cost-utility and cost-effectiveness analysis of disease-modifying drugs of relapsing–remitting multiple sclerosis: a systematic review

“…Fig. 1 Flow chart of the study selection process using a 31-health-state Markov model [43], one study conducted CEA using a 5-year cohort-based Markov model [44], one study conducted CEA using a 1-year cycle cohort-based Markov state transition model [45], one study conducted CEA using a lifetime Markov model [46], five studies conducted CEA [2,[47][48][49][50], two studies conducted both CEA and CBA [10,51], one study conducted CEA using simulation model [52], one study conducted CEA using a treatment-sequence model [53], one study conducted CUA and budget impact analysis (BIA) using a Markov state transition model [54], one study conducted CEA using a published Markov structure with health states based on the Expanded Disability Status Scale (EDSS) [55], one study conducted CEA using a Markov state transition model [56], one study conducted CEA using a Markov economic model [57], five studies conducted CEA using a cohort Markov economic model [10,13,17,51,58], one study conducted CEA using a microsimulation model [19], one study conducted CEA using a discrete-time Markov model [59], one study condcuted CEA using a cohort-based multi-state Markov model [60], and one study conducted CEA using a probabilistic Markov model (second-order Monte Carlo simulation) [61] (Table 2).…”

“…Seven studies had no sponsorship [24,26,35,44,46,51,63]. The time horizon was variable; in some articles, it was between 5-10 or over [18,23,26,51] years, while in others, it was 50 years or over [28,39,41,42,54,56]. Discount rates were very similar, mostly between 3% and 5-6%.…”

“…In three studies, in addition to these two forms of medications, the best supportive care (BSC) strategy [10,30] and symptom management [24] were included in cost-effectiveness analysis. Eight studies analyzed both oral and intravenous infusions DMDs of RRMS [32,38,40,44,54,55,57,58]. Ten studies analyzed all three types of DMDs of RRMS [13,19,23,33,34,37,49,53,56,64].…”

“…Commercial in confidence estimates of efficacy, the most favorable estimate is £35 000 per QALY and the least favorable is £104 000 per QALY --- tweleve studies compared DMDs in patients with highly active RRMS (HARRMS) [22,32,34,38,39,41,44,45,[54][55][56][57]61].…”

“…A study in Lebonan demonstrated cladribine tablets were a cost-effective (less costly and more effective in terms of QALY) and budget-saving treatment option for the treatment of HDA RMS patients when compared with alemtuzumab, fingolimod, and natalizumab [54]. Similarly, Michels et al in the Netherlands showed treatment of RRMS with cladribine tablets was cost-effective versus alemtuzumab and fingolimod in HDA patients, and cost-effective versus natalizumab in rapidly evolving severe (RES) patients, at a threshold of €50,000/QALY gained [32].…”