Cost-minimization analysis of fingolimod compared with natalizumab for the treatment of relapsing–remitting multiple sclerosis in Sweden

Abstract

Background:

Fingolimod and natalizumab have the same European Union licence for the treatment of relapsing multiple sclerosis, and are considered by the Committee for Medicinal Products for Human Use (CHMP) to have broadly similar efficacy.

Objective:

A cost-minimization analysis was performed to compare differences in treatment costs between fingolimod and natalizumab from a societal perspective in Sweden.

Methods:

This analysis included costs associated with initiating and following treatment (physician visits and monitoring), continuing therapy (drugs and administration), and lost patient productivity and leisure time. Unit costs (in Swedish krona [SEK]) were based on regional data (median prices for physician visits and monitoring sessions). Natalizumab infusion costs were obtained from the national cost-per-patient database. Drug costs for both therapies were 15,651 SEK/28 days.

Results:

After 3 years, fingolimod use was associated with savings of 124,823 SEK/patient compared with natalizumab (total cost/patient: 566,718 SEK vs 691,542 SEK). Cost savings with fingolimod were 40,402 SEK/patient after 1 year and 301,730 SEK/patient after 10 years. Treatment with natalizumab was 18% more expensive than fingolimod therapy after 1 year and 23% more expensive after 10 years.

Limitations:

Based on the CHMP assessment, it was assumed that fingolimod and natalizumab have similar efficacy. The analysis was conducted for Sweden, and caution is needed in extrapolating the results to other countries.

Conclusion:

Fingolimod is cost-saving compared with natalizumab for the treatment of relapsing–remitting multiple sclerosis in Sweden.

Key words::

• Multiple sclerosis
• Fingolimod
• Natalizumab
• Cost-minimization
• Sweden
• Costs

Transparency

Declaration of funding

This study was funded by Novartis Sweden AB. The study was designed by Niklas Bergvall, Magnus Tambour, and Freddie Henriksson, and data were gathered and analyzed by Novartis. All authors contributed to the interpretation of the data, were involved in drafting and reviewing the manuscript, and approved the submitted paper.

Declaration of financial/other relationships

Professor Fredrikson has received honoraria for lectures, consultancy, and educational activities from Allergan, Bayer, Biogen Idec, Genzyme, Merck-Serono, Novartis, Sanofi-Aventis, and Teva. Dr Tambour is an employee of Novartis and reports having equity interests in Novartis. Drs Bergvall and Henriksson are employees of Novartis.

Acknowledgments

Dr Gemma Carter (Oxford PharmaGenesis, Ltd) provided medical writing support, editorial assistance, and collation and incorporation of comments from all authors. Such editorial help was funded by Novartis Pharma AG, Basel, Switzerland.

Previous presentation

The results of this analysis were presented as a poster at the 22nd meeting of the European Neurological Society (ENS) on 9–12 June 2012 in Prague, Czech Republic.