Cost-consequence analysis of early vs. delayed natalizumab use in highly active relapsing-remitting multiple...

Area of Science:

• Pharmacoeconomics
• Neurology
• Health Services Research

Background:

• Natalizumab (NAT) is an effective disease-modifying therapy (DMT) for highly active multiple sclerosis (MS).
• Complex decision-making often leads to initial use of less effective therapies.
• The availability of a biosimilar NAT allows for competitive pricing, influencing treatment strategies.

Purpose of the Study:

• To assess the societal implications of initiating natalizumab (NAT) in multiple sclerosis (MS) treatment.
• To compare different NAT initiation scenarios (continuous, early switch, delayed switch) using a cost-consequence analysis.

Main Methods:

• A 10-year Markov model utilizing the Expanded Disability Status Scale (EDSS) with 11 health states was employed.
• Natalizumab was compared against common initial DMTs (glatiramer acetate, teriflunomide, dimethyl fumarate, fingolimod).
• Scenarios included continuous NAT use, switching to NAT after 1 year, and switching after 5 years.

Main Results:

• Continuous NAT use maximized time spent at lower EDSS levels, reduced relapses, and improved employment rates over 10 years.
• Switching to NAT after 1 year demonstrated outcomes comparable to continuous NAT use.
• Despite higher initial DMT costs, continuous and early NAT use led to lower overall disease management costs, including indirect and non-DMT medical costs.

Conclusions:

• Continuous and early initiation of natalizumab (NAT) in multiple sclerosis (MS) yields superior clinical outcomes.
• Early NAT use significantly lowers the overall societal economic burden compared to delayed initiation.
• These findings suggest potential for substantial long-term cost savings with earlier adoption of NAT.