Comparative effectiveness and cost-effectiveness of natalizumab and fingolimod in rapidly evolving severe relapsing-remitting multiple sclerosis in the United Kingdom

Aim: To evaluate the real-world comparative effectiveness and the cost-effectiveness, from a UK National Health Service perspective, of natalizumab versus fingolimod in patients with rapidly evolving severe relapsing-remitting multiple sclerosis (RES-RRMS). Methods: Real-world data from the MSBase R...

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Autores: Spelman, Tim|||0000-0001-9204-3216, Herring, William L.|||0000-0001-8222-9914, Acosta, Carlos|||0000-0002-7257-8675, Hyde, Robert|||0000-0002-3035-5369, Jokubaitis, V.|||0000-0002-3942-4340, Pucci, Eugenio, Lugaresi, Alessandra|||0000-0003-2902-5589, Laureys, Guy, Kubala Havrdova, Eva|||0000-0002-9543-4359, Horáková, Dana, Izquierdo, Guillermo|||0000-0002-6340-5609, Eichau Madueño, Sara, Ozakbas, Serkan, Alroughani, Raed A., Kalincik, Tomas|||0000-0003-3778-1376, Duquette, Pierre Pascal, Girard, Marc, Petersen, Thor|||0000-0001-5633-2600, Patti, Francesco|||0000-0002-6923-0846, Csepany, Tunde|||0000-0002-8305-3209, Granella, Franco, Grand'Maison, François, Ferraro, Diana, Karabudak, Rana, José Sà, Maria, Trojano, Maria|||0000-0002-6329-8946, van Pesch, Vincent|||0000-0003-2885-9004, van Wijmeersch, Bart, Cartechini, Elisabetta, McCombe, Pamela A., Gerlach, Oliver H. H., Spitaleri, Daniele Litterio A., Rozsa, Csilla S., Hodgkinson, Suzanne J., Bergamaschi, Roberto, Gouider, Riadh, Soysal, Aysun, Castillo-Triviño, Tamara|||0000-0002-9249-3185, Prevost, Julie, Garber, Justin Y., de Gans, Koen, Ampapa, Radek, Simo, Magdolna, Sánchez Menoyo, José Luis|||0000-0003-2634-8294, Iuliano, Gerardo, Sas, Attila, van der Walt, A., John, Nevin, Gray, Orla M., Hughes, Stella E., De Luca, Giovanna|||0000-0002-7693-2256, Onofrj, Marco|||0000-0002-0480-2495, Buzzard, Katherine A., Skibina, Olga G., Terzi, Murat, Slee, Mark|||0000-0003-4323-2453, Solaro, Claudio Marcello|||0000-0002-6713-4623, Oreja-Guevara, Celia|||0000-0002-9221-5716, Ramo-Tello, Cristina|||0000-0001-8643-5053, Fragoso, Yára Dadalti, Shaygannejad, Vahid, Moore, Fraser G. A., Rajda, Cecília, Agüera-Morales, Eduardo|||0000-0002-8604-2054, Butzkueven, Helmut|||0000-0003-3940-8727
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:311627
Acceso en línea:https://ddd.uab.cat/record/311627
https://dx.doi.org/urn:doi:10.1080/13696998.2023.2293379
Access Level:acceso abierto
Palabra clave:Multiple sclerosis
Natalizumab
Fingolimod
Real-world data
Comparative effectiveness
Cost-effectiveness
Descripción
Sumario:Aim: To evaluate the real-world comparative effectiveness and the cost-effectiveness, from a UK National Health Service perspective, of natalizumab versus fingolimod in patients with rapidly evolving severe relapsing-remitting multiple sclerosis (RES-RRMS). Methods: Real-world data from the MSBase Registry were obtained for patients with RES-RRMS who were previously either naive to disease-modifying therapies or had been treated with interferon-based therapies, glatiramer acetate, dimethyl fumarate, or teriflunomide (collectively known as BRACETD). Matched cohorts were selected by 3-way multinomial propensity score matching, and the annualized relapse rate (ARR) and 6-month-confirmed disability worsening (CDW6M) and improvement (CDI6M) were compared between treatment groups. Comparative effectiveness results were used in a cost-effectiveness model comparing natalizumab and fingolimod, using an established Markov structure over a lifetime horizon with health states based on the Expanded Disability Status Scale. Additional model data sources included the UK MS Survey 2015, published literature, and publicly available sources. Results: In the comparative effectiveness analysis, we found a significantly lower ARR for patients starting natalizumab compared with fingolimod (rate ratio [RR] = 0.65; 95% confidence interval [CI], 0.57-0.73) or BRACETD (RR = 0.46; 95% CI, 0.42-0.53). Similarly, CDI6M was higher for patients starting natalizumab compared with fingolimod (hazard ratio [HR] = 1.25; 95% CI, 1.01-1.55) and BRACETD (HR = 1.46; 95% CI, 1.16-1.85). In patients starting fingolimod, we found a lower ARR (RR = 0.72; 95% CI, 0.65-0.80) compared with starting BRACETD, but no difference in CDI6M (HR = 1.17; 95% CI, 0.91-1.50). Differences in CDW6M were not found between the treatment groups. In the base-case cost-effectiveness analysis, natalizumab dominated fingolimod (0.302 higher quality-adjusted life-years [QALYs] and £17,141 lower predicted lifetime costs). Similar cost-effectiveness results were observed across sensitivity analyses. Conclusions: This MSBase Registry analysis suggests that natalizumab improves clinical outcomes when compared with fingolimod, which translates to higher QALYs and lower costs in UK patients with RES-RRMS.

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