A Multiple Treatment Comparison of Eleven Disease-Modifying Drugs Used for Multiple Sclerosis

Area of Science:

• Neurology
• Pharmacoeconomics
• Clinical Effectiveness Research

Background:

• Multiple sclerosis (MS) management involves several disease-modifying therapies.
• Assessing the comparative effectiveness and cost-effectiveness of these drugs is crucial for optimal patient care.

Purpose of the Study:

• To systematically review and analyze the effectiveness and cost-effectiveness of disease-modifying drugs for relapsing-remitting multiple sclerosis.
• To identify the most appropriate and economically viable treatment strategies.

Main Methods:

• Conducted a systematic review and network meta-analysis of 11 disease-modifying drugs for relapsing-remitting MS.
• Evaluated endpoints including relapse rates, disability progression, adverse events, and mortality.
• Developed a decision model to assess cost-effectiveness, incorporating quality-adjusted life years (QALYs) and performing sensitivity analyses.

Main Results:

• Alemtuzumab 12 mg demonstrated the highest effectiveness in reducing annual relapse rates.
• Dimethyl fumarate and fingolimod showed effectiveness in managing disability progression.
• Alemtuzumab was identified as more effective and less costly, improving QALYs.
• Interferon beta-1b (Extavia), peg-interferon beta-1a, and natalizumab were found to be potentially cost-effective depending on the willingness-to-pay threshold.

Conclusions:

• Alemtuzumab offers a superior balance of effectiveness and cost compared to other MS treatments.
• Initiating treatment with more effective and less costly alternatives like alemtuzumab presents significant potential for healthcare cost savings.