Cost–effectiveness of natalizumab in multiple sclerosis

Abstract

Natalizumab (Tyasabri^®) is the first monoclonal antibody approved for use in relapsing-remitting multiple sclerosis. Based on indirect comparison, it seems more effective than alternative drugs in terms of reductions in disability progression, relapse rate and increase in quality of life during the initial 2 years of treatment. The annual direct drug cost of natalizumab is approximately €25,500 compared with €12,800–13,500 for alternative drugs, and the budgetary implications make it important to compare the health benefit and the cost of treatment. However, the long-term effect on disability and quality of life is uncertain, and neither the effect as second-line monotherapy nor the effect compared with alternative treatments has been established. The manufacturer has calculated cost per quality-adjusted life year to €36,000–64,000 compared with alternative drugs and €46,500–76,000 compared with best supportive care. Two studies comparing cost per relapse avoided with other drugs have reached conflicting results. Given the high socioeconomic burden of multiple sclerosis, natalizumab may be cost effective from a societal perspective, however, the models used to reach this conclusion rest on several uncertain assumptions.

Keywords::

• cost–effectiveness
• multiple sclerosis
• natalizumab
• pharmacoeconomics
• quality of life

Financial & competing interests disclosure

Trygve Holmoy has received research grants and speech honoraria from Sanofi-Aventis and travel support from Merck-Serono. Elisabeth Gulowsen Celius has received travel support from Biogen Idec, Sanofi-Aventis, Schering and Serono. This work was funded by the University of Oslo. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.