Cost-minimization analysis of alemtuzumab compared to fingolimod and natalizumab for the treatment of active relapsing-remitting multiple sclerosis in the Netherlands

Figures & data

Table 1. Unit costs and units required for drug acquisition, drug administration, and monitoring.

	Unit cost (€)^a	Fingolimod		Natalizumab		Alemtuzumab
		Year 1	Year 2+	Year 1	Year 2+	Course 1	Course 2+	Monitoring period^b	Post-monitoring^c
Drug acquisition^25
Fingolimod 0.5 mg	62	365	365	—	—	—	—	—	—
Natalizumab 300 mg	1,650	—	—	13	13	—	—	—	—
Alemtuzumab 12 mg	7,000	—	—	—	—	5	3	—	—
Methylprednisolone 1,000 mg	30	—	—	—	—	5	3	—	—
Aciclovir 400 mg	0.18	—	—	—	—	56	56	—	—
Ranitidine 150 mg	0.02	—	—	—	—	10	6	—	—
Tavegyl 1 mg	0.14	—	—	—	—	10	6	—	—
Administration
Hospital admission	556^28	—	—	—	—	5	3	—	—
Outpatient administration	282^28	1	—	13	13	—	—	—	—
Evaluation ECG	44^28	2	—	—	—	—	—	—	—
Regular preparation	12^28	—	—	13	13	5	3	—	—
Monitoring
Neurologist visit	124^28	5	2	3	2	5	4	4	2
MS nurse hour	64^28	4	4	4	4	4	4	4	4
MRI with contrast	416^26	2	1	2	1	2	1	1	1
Blood withdrawal	11^26	5	2	3	2	13	12	12	4
CBC incl. differential	7^26	5	2	3	2	13	12	12	4
Liver function test	10^26	5	2	3	2	1	1	—	—
Serum creatinine	2^26	—	—	—	—	13	12	12	—
Thyroid function	14^26	—	—	—	—	5	4	4	4
Urine screening	4^26	—	—	—	—	13	12	12	—
Test for VZV antibodies	11^26	1	—	—	—	1	—	—	—
VZV vaccination	94^26	0.1	—	—	—	0.1	—	—	—
Test for VZV antibodies after vaccination	11^26	0.1	—	—	—	0.1	—	—	—
Pregnancy test	7^26	0.57^d	—	0.57^d	—	0.57^d	—	—	—
Hepatitis serology	23^26	—	—	—	—	1	—	—	—
TBC test	31^26	—	—	—	—	1	—	—	—
Cervical screening gynecologist	124^28	—	—	—	—	1.42	0.71	0.71
HPV test analysis	142^26	—	—	—	—	1.42	0.71	0.71
HIV test	11^26	—	—	—	—	1	—	—	—
Ophthalmologist pre-treatment	155^28	0.026	—	—	—	—	—	—	—
Ophthalmologist	155^28	1	—	—	—	—	—	—	—
Anti-JCV antibody test	11^26	—	—	3	2	—	—	—	—
Drug costs (€)^a		22,487	22,487	21,450	21,450	35,161	21,101	—	—
Administration costs (€)^a		370	—	3,830	3,830	2,840	1,704	—	—
Monitoring costs (€)^a		2,029	974	1,579	996	2,558	1,701	1,691	1,045
Total annual costs (€)^a		24,886	23,461	26,859	26,276	40,559	24,506	1,691	1,045

Abbreviations. CBC, complete blood count; CD4/8, cluster of differentiation 4/8; ECG, electrocardiogram; HIV, human immunodeficiency virus; HPV, human papilloma virus; JCV, JC virus; MRI, magnetic resonance imaging; TBC, tuberculosis; VZV, varicella zoster virus.

^a The product of unit costs and resource use may not be equal to the reported total cost due to rounding.

^b Applies to 3 years after the year in which the last course of alemtuzumab was received.

^c Applies to years beyond the monitoring period.

^d 80% of women were assumed of fertile age (80% * 71% = 57%).

Table 2. Base case results at 5 years.

	Drug acquisition	Administration	Monitoring	Total discounted costs (95% CI)		Incremental costs (95% CI)
Alemtuzumab	€65,701	€5,307	€8,709	€79,717	(€76,779; €83,036)	—
Fingolimod	€104,111	€370	€5,563	€110,044	(€108,618; €111,716)	−€30,327	(−€32,579; −€27,536)
Natalizumab	€99,311	€17,732	€5,195	€122,238	(€116,317; €129,754)	−€42,522	(−€50,238; −€36,186)

Incremental costs were calculated with respect to alemtuzumab; thus, negative incremental costs reflect cost savings associated with alemtuzumab. Abbreviation. CI, confidence interval.

Figure 1. A. Undiscounted costs per average patient per year for alemtuzumab, fingolimod and natalizumab. Average alemtuzumab costs decrease sharply after 2 years, because of a decreasing number of patients requiring courses. B. Cumulative discounted costs per average patient for alemtuzumab, fingolimod and natalizumab after 1 to 5 years. Alemtuzumab costs intersect with natalizumab costs at approximately 2.8 years, and with fingolimod costs at 3.3 years.

Figure 2. Overview of the 5-year results of the deterministic univariate sensitivity analyses of alemtuzumab versus fingolimod (A) and natalizumab (B). The bars represent the impact on incremental (discounted) costs when varying the parameters one by one to the lower and upper bounds of their 95% CIs.

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