Cost-effectiveness of fingolimod versus interferon beta-1a for relapsing remitting multiple sclerosis in the United States

Abstract

Objective:

Fingolimod has been shown to be more efficacious than interferon (IFN) beta-1a, but at a higher drug acquisition cost. The aim of this study was to assess the cost-effectiveness of fingolimod compared to IFN beta-1a in patients diagnosed with relapsing-remitting multiple sclerosis (RRMS) in the US.

Methods:

A Markov model comparing fingolimod to intramuscular IFN beta-1a using a US societal perspective and a 10-year time horizon was developed. A cohort of 37-year-old patients with RRMS and a Kurtzke Expanded Disability Status Scale score of 0–2.5 were assumed. Data sources included the Trial Assessing Injectable Interferon vs FTY720 Oral in Relapsing–Remitting Multiple Sclerosis (TRANSFORMS) and other published studies of MS. Outcomes included costs in 2011 US dollars, quality-adjusted life years (QALYs), number of relapses avoided, and incremental cost-effectiveness ratios (ICERs).

Results:

Compared to IFN beta-1a, fingolimod was associated with fewer relapses (0.41 vs 0.73 per patient per year) and more QALYs gained (6.7663 vs 5.9503), but at a higher cost ($565,598 vs $505,234). This resulted in an ICER of $73,975 per QALY. Results were most sensitive to changes in drug costs and the disutility of receiving IFN beta-1a. Monte Carlo simulation demonstrated fingolimod was cost-effective in 35% and 70% of 10,000 iterations, assuming willingness-to-pay thresholds of $50,000 and $100,000 per QALY, respectively.

Limitations:

Event rates were primarily derived from a single randomized clinical trial with 1-year duration of follow-up and extrapolated to a 10-year time horizon. Comparison was made to only one disease-modifying drug—intramuscular IFN beta-1a.

Conclusion:

Fingolimod use is not likely to be cost-effective compared to IFN beta-1a unless fingolimod cost falls below $3476 per month or a higher than normal willingness-to-pay threshold is accepted by decision-makers.

• Cost-effectiveness
• Decision analysis
• Fingolimod
• Interferon beta
• Multiple sclerosis
• Relapsing
• remitting

Transparency

Declaration of funding

This study was not funded.

Declaration of financial/other relationships

Dr Coleman has no relevant financial relationships to disclose regarding this paper. However, he has disclosed that he has received past research funding from the Agency for Healthcare Research and Quality (AHRQ), Acorda Therapeutics, and Janssen Pharmaceuticals Inc. The other authors have no relevant financial relationships to disclose.

Author contributions

Drs Lee and Coleman had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Lee, Roberts, Coleman. Acquisition of data: Lee, Baxter, Limone, Roberts, Coleman. Analysis and interpretation of data: Lee, Baxter, Limone, Coleman. Drafting of the manuscript: Lee, Baxter, Coleman. Critical revision of the manuscript for important intellectual content: Lee, Baxter, Coleman. Statistical analysis: Lee, Baxter, Roberts, Coleman. Administrative, technical, or material support: Lee, Baxter, Roberts, Limone, Coleman. Study supervision: Lee, Coleman.