Cost-effectiveness of First-line disease-modifying treatments for relapsing-remitting MS
Author(s): ,
E. Soini
ESiOR Oy, Kuopio
J. Joutseno
Genzyme, a Sanofi company, Helsinki
M.-L. Sumelahti
School of Medicine, University of Tampere, Tampere, Finland
ECTRIMS Online Library. Sumelahti M. 10/08/15; 115787; 1081
Marja-Liisa Sumelahti
Marja-Liisa Sumelahti
Abstract: P660

Type: Poster

Abstract Category: Others

Background: Patients with relapsing-remitting MS (RRMS) are in need of therapies with improved efficacy, tolerability, and convenience than the widely used injectable disease modifying treatments (DMTs). Recently, general reimbursement was granted for 2 oral, first-line DMTs in Finland. Teriflunomide is the only first-line DMT with significant reduction in both relapses and 3-month disability progression in 2 pivotal clinical trials.

Objectives: To evaluate the cost-effectiveness of the oral agents teriflunomide 14mg once daily and dimethyl fumarate (DMF) 240mg twice daily; subcutaneous therapies glatiramer acetate (GA) 20mg daily, interferon (IFN)β-1a 44µg 3x/week, and IFNβ-1b 250µg every other day; intramuscular IFNβ-1a 30µg once weekly; and best supportive care (BSC) as first-line treatments for RRMS in the Finnish healthcare payer setting.

Methods: Markov cohort modelling with a 20-year time horizon (3%/year discount rate) was employed. The primary outcome was incremental cost-effectiveness ratio (ICER; cost [€] per quality-adjusted life year [QALY] gained vs non-dominated alternatives). During each 1-year modelling cycle, patients could maintain Expanded Disability Status Scale (EDSS) score or experience progression, develop secondary-progressive MS (SPMS), have EDSS progression in SPMS, or experience relapse with/without hospitalization or death. Specific annual adverse event risks were included. Patient characteristics, standardized mortality ratios, and a RRMS progression matrix were derived from a Finnish MS registry.

A mixed-treatment comparison informed treatment effects. EQ-5D quality-of-life estimates and Finnish direct costs were associated with EDSS scores, relapses, and adverse events. Robustness of the base case results was tested with sensitivity analyses.

Results: Teriflunomide was dominant (less costly, higher QALYs) compared with GA and IFNs, and had the lowest ICER of 17,326 vs BSC. DMF brought marginally more QALYs than teriflunomide (0.129 over 20 years), but the QALY difference was associated with relatively high costs, and the ICER for DMF vs teriflunomide was 78,092. In the probabilistic sensitivity analyses of teriflunomide vs other first-line DMTs, teriflunomide had over 50% probability to be cost-effective with willingness-to-pay values below €94,000/QALY gained.

Conclusions: In our analysis, teriflunomide 14mg once daily was cost-effective compared with DMF twice daily, and dominated all other first-line DMTs for RRMS in Finland.


Study supported by Genzyme, a Sanofi company.

ES works for and is a shareholder in a health economic consultancy (ESiOR Oy, Kuopio, Finland). ES declares no other potential conflict of interest.

JJ works for the marketer of teriflunomide (Genzyme, a Sanofi Company, Helsinki, Finland). JJ declares no other potential conflict of interest.

MLS has consultancies and memberships in advisory councils for Genzyme, Novartis and Biogen. MLS has received travel grant from Novartis. MLS declares no other potential conflict of interest.

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