Cost-effectiveness of Alemtuzumab vs. Natalizumab in the third line treatment of relapsing-remitting multiple sclerosis for brazilian supplementary health

Abstract

Objective: Multiple sclerosis is a chronic, inflammatory and degenerative disease of the central nervous system, affecting approximately 2.5 million people worldwide. About 80% of multiple sclerosis cases are classified as ‘recurrent remitting’. Cost-effectiveness of alemtuzumab treatment in RRMS patients in the third line of treatment, was evaluated versus natalizumab, the only one available at supplementary health in Brazil. Method: Using a Markov model, a cohort of a thousand patients with demographic parameters based on data from the Brazilian health system was simulated over a 30-year timeframe. In each annual cycle, patients could move between different health states, measured by the Expanded Disability Status Scale (EDSS) score. Additionally, patients could experience relapses and progression to the secondarily progressive type. The initial EDSS cohort distribution was based on the CARE MS II clinical trial. The efficacy parameters related to the progression of disability and rate of outbreaks were selected from the network meta-analysis. Rates of discontinuation, retreatment, and utility, safety and disease cost information were obtained from clinical trials and published studies. Dose and administration costs were taken from official price lists. We demonstrate that alemtuzumab is dominant, accumulating more QALYs (6,752) for a lower total cost of treatment (R$ 377.9 million) than natalizumab (5,652, R$ 432.9 million). Results: Alemtuzumab has advantages on long-term efficacy and effectiveness in reducing the occurrence of outbreaks and hospitalizations. Parametric uncertainties of the economic model were accessed through deterministic and probabilistic sensitivity analyzes. The sensitivity analysis corroborates these results, because even with the variation of uncertain parameters, alemtuzumab still has a 97.8% probability of being cost-effective compared to natalizumab, considering the threshold of 3 PIBs per capita. Conclusion: Alemtuzumab is a cost-effective therapy, proving to be an economically viable alternative. Cost-effectiveness analysis such as this one are important to optimize the decision making process of healthcare managers, both public and private.