Cost-Effectiveness of Fingolimod in Treating Patients With Relapsing-Remitting Multiple Sclerosis

Objectives: To estimate cost per relapse avoided with a new oral disease-modifying therapy (DMT), fingolimod, for relapsing-remitting multiple sclerosis (RRMS) in a hypothetical managed care plan. Study Design: An Excel-based model was developed to estimate the cost-effectiveness of fingolimod in patients with RRMS receiving first-line DMTs. Methods: Comparators included fingolimod, subcutaneous (SC) and intramuscular (IM) interferon- beta (IFN beta-1a and IFN beta-1b), and glatiramer. The cost per relapse avoided for each product over 2 years included drug acquisition costs, direct costs of managing relapses, and monitoring costs. Cost data were derived from published sources; efficacy data were obtained from respective placebo-controlled clinical trials. A subanalysis was conducted using data from a head-to-head clinical trial of fingolimod and IM IFN beta-1a. Results: Fingolimod was the most cost-effective DMT (2-year cost per relapse avoided: $ 74,843), followed by SC IFN beta-1b (Extavia: $ 94,423), SC IFN beta-1b (Betaseron: $ 102,530), SC IFN beta-1a ($ 108,940), glatiramer ($ 124,512), and IM IFN beta-1a ($ 197,073). In the subanalysis, the cost per relapse avoided was $ 82,016 for fingolimod 0.5 mg compared with $ 96,282 for IM IFN beta-1a 30 mu g. Univariate sensitivity analysis indicated that the results were most sensitive to drug acquisition cost of fingolimod and number of relapses in untreated patients. Conclusions: Fingolimod had the lowest cost per relapse avoided compared with other DMTs used in first-line therapy. This costeffectiveness was due to its efficacy in reducing relapses in clinical trials.