Cost-effectiveness of glatiramer acetate and interferon beta-1a for relapsing-remitting multiple sclerosis, based on the CombiRx study

Abstract

Background:

To assess the cost-effectiveness of the Disease Modifying Treatments (DMT), Glatiramer Acetate (GA) and Interferon beta-1a (IFN) in monotherapy alone and in combination for the prevention of relapses among Spanish patients aged between 18–60 years old with established Relapsing–Remitting Multiple Sclerosis (RRMS).

Methods:

A Markov model was developed to represent the transition of a cohort of patients over a 10 year period using the perspective of the Spanish National Health Service (NHS). The model considered five different health states with 1-year cycles including without relapse, patients with suspect, non-protocol defined and protocol defined exacerbations, as well as a category information lost. Efficacy data was obtained from the 3-year CombiRx Study. Costs were reported in 2013 Euros and a 3% discount rate was applied for health and benefits. Deterministic results were presented as the annual treatment cost for the number of relapses. A probabilistic sensitivity analysis was performed to test the robustness of the model.

Results:

Deterministic results showed that the expected annual cost per patient was lower when treated with GA (€13,843) compared with IFN (€15,589) and the combined treatment with IFN + GA (€21,539). The annual number of relapses were lower in the GA cohort with 3.81 vs 4.18 in the IFN cohort and 4.08 in the cohort treated with IFN + GA. Results from probabilistic sensitivity analysis showed that GA has a higher probability of being cost-effective than treatment with IFN or IFN + GA for threshold values from €28,000 onwards, independent of the maximum that the Spanish NHS is willing to pay for avoiding relapses.

Conclusion:

GA was shown to be a cost-effective treatment option for the prevention of relapses in Spanish patients diagnosed with RRMS. When GA in monotherapy is compared with INF in monotherapy and IFN + GA combined, it may be concluded that the first is the dominant strategy.

• Relapsing
• remitting multiple sclerosis
• Cost-effectiveness
• Disease modifying drugs
• Glatiramer acetate
• Interferon beta-1a

Transparency

Declaration of funding

Funding for the development of this manuscript was supplied by TEVA Pharmaceuticals Corporation.

Declaration of financial/other interests

JD is employed by the University of Barcelona and has no relevant financial relationships to disclose. LK is an employee of BCN Health Economics & Outcomes Research S.L., Barcelona, Spain, an independent contract health economic organization that has received research funding from Teva Pharmaceutical. RS is employed by Teva Pharmaceutical and works at the Medical & HEOR Department. JME Peer Reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Dr Darbá’s and Mrs Kaskens’s contributions included designing the study, extracting data, conducting the analysis, and writing the draft and final manuscript. Dr Sanchez-de la Rosa’s contributions included designing the study, definition of study objective and analysis strategy, and reviewing the draft and final manuscript. Dr Darbá is guarantor of the manuscript.