Incremental net monetary benefit of ocrelizumab relative to subcutaneous interferon β-1a

Figures & data

Figure 1. Simplified schematic of Markov model.

Table 1. Parameters used in the base case model and ranges for the sensitivity analysis.

Parameter	Base case value^a	Sensitivity analysis	Reference
Disability progression treatment effect (hazard ratio)
Ocrelizumab vs IFNβ-1a SC	0.60	0.45–0.81^b	OPERA trials^Citation23
IFNβ-1a SC vs placebo	0.62	0.43–0.91^b	Ebers^Citation33
Annualized relapse rate ratio
Ocrelizumab vs IFNβ-1a SC	0.53		OPERA trials^Citation23
IFNβ-1a SC vs placebo	0.67		Ebers^Citation33
Direct costs
EDSS 1–3	$6,146	±10%	Kobelt et al.^Citation22
EDSS 4–6	$10,475	±10%
EDSS 7–9	$20,557	±10%
Mild/moderate relapse	$9,129	±10%	Parisé et al.^Citation38
Severe relapse	$22,578	±10%
Indirect costs
EDSS 1–3	$12,443	±10%	Kobelt et al.^Citation22
EDSS 4–6	$27,858	±10%
EDSS 7–9	$25,590	±10%
Mild/moderate relapse	$1,038	±10%	Parisé et al.^Citation38
Severe relapse	$1,965	±10%
Informal care costs
EDSS 1–3	$1,439	±10%	Kobelt et al.^Citation22
EDSS 4–6	$4,428	±10%
EDSS 7–9	$16,520	±10%
Any relapse	$5,399	±10%	Oleen-Burkey et al.^Citation39
Annual costs of therapy
Ocrelizumab	$65,000	±10%	WAC at launch
IFNβ-1a SC	$75,577		Red Book WAC July 2016
Utilities
EDSS 1–3	0.824	±10%	Kobelt et al.^Citation22
EDSS 4–6	0.679	±10%
EDSS 7–9	0.533	0.20–0.60
Mild/moderate relapse disutility	–0.0114	±10%	Lee et al.^Citation40
Severe relapse disutility	–0.0378	±10%
Value of a QALY	$150,000	50,000–250,000	See footnote^c
Proportion of relapse
Mild/moderate	0.7		Parisé et al.^Citation38
Severe	0.3

^a Annual costs in 2016 USD; utilities measured by EQ-5D.

^b 95% confidence interval.

^c Braithwaite et al.⁴⁴; Grabowski et al.⁴⁸; Jena et al.⁴⁹; Neumann et al.⁴⁶; Philipson et al.⁵⁰; Weinstein⁴⁵.

EDSS, Expanded Disability Status Scale; IFN, interferon; QALY, quality-adjusted life year; SC, subcutaneous; WAC, wholesale acquisition cost.

Figure 2. Cumulative value of ocrelizumab relative to interferon β-1a subcutaneous.

Table 2. Discounted health benefits and cost per person over 30-year horizon.

	Interferon β-1a SC	Ocrelizumab	Difference [OCR – IFNβ-1a SC]
QALYs	10.46	11.29	0.84
Direct	$194,031	$149,633	−$44,399
Indirect	$333,334	$329,697	−$3,637
Informal	$120,591	$92,013	−$28,579
Treatment	$1,226,309	$1,015,211	−$211,099
All Costs	$1,874,266	$1,586,553	−$287,713
Monetized QALYs	$1,568,282	$1,694,180	$125,898
Incremental Net Monetary Benefit (INMB)			$413,611

IFN, interferon; QALY, quality-adjusted life year; SC, subcutaneous.

Figure 3. Cumulative incremental net monetary benefit (INMB) of ocrelizumab relative to interferon β-1a subcutaneous, by starting EDSS level.

Figure 4. Tornado diagram of one-way sensitivity analysis.

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