Comparative Effectiveness and Cost-Effectiveness of Natalizumab and Fingolimod in Patients with Inadequate Response to Disease-Modifying Therapies in Relapsing-Remitting Multiple Sclerosis in the United Kingdom

作者：Timothy Spelman, William L. Herring, Yuanhui Zhang, Michael Tempest, Isobel Pearson, Ulrich Freudensprung, Carlos Acosta, T. Dort, Robert Hyde, Eva Havrdová, Dana Horáková, María Trojano, Giovanna De Luca, Alessandra Lugaresi, Guillermo Izquierdo, Pierre Grammond, Pierre Duquette, Raed Alroughani, Eugenio Pucci, Franco Granella, Jeannette Lechner‐Scott, Patrizia Sola, Diana Ferraro, François Grand’Maison, Murat Terzi, Csilla Rózsa, Cavit Boz, Raymond Hupperts, Vincent Van Pesch, Celia Oreja‐Guevara, Anneke van der Walt, Vilija Jokubaitis, Tomáš Kalinčík, Helmut Butzkueven, The MSBase Investigators, Timothy Spelman, Eva Havrdová, Dana Horáková, María Trojano, Giovanna De Luca, Alessandra Lugaresi, Guillermo Izquierdo, Pierre Grammond, Pierre Duquette, Raed Alroughani, Eugenio Pucci, Franco Granella, Jeannette Lechner‐Scott, Patrizia Sola, Diana Ferraro, François Grand’Maison, Murat Terzi, Csilla Rózsa, Cavit Boz, Raymond Hupperts, Vincent Van Pesch, Celia Oreja‐Guevara, Anneke van der Walt, V. Jokubaitis, Tomáš Kalinčík, Helmut Butzkueven · 发表于：PharmacoEconomics · 年份：2021 · DOI：10.1007/s40273-021-01106-6 · 被引用次数：11 · 研究领域：Multiple Sclerosis Research Studies、Peripheral Neuropathies and Disorders、Polyomavirus and related diseases

BACKGROUND: Patients with highly active relapsing-remitting multiple sclerosis inadequately responding to first-line therapies (interferon-based therapies, glatiramer acetate, dimethyl fumarate, and teriflunomide, known collectively as "BRACETD") often switch to natalizumab or fingolimod. OBJECTIVE: The aim was to estimate the comparative effectiveness of switching to natalizumab or fingolimod or within BRACETD using real-world data and to evaluate the cost-effectiveness of switching to natalizumab versus fingolimod using a United Kingdom (UK) third-party payer perspective. METHODS: Real-world data were obtained from MSBase for patients relapsing on BRACETD in the year before switching to natalizumab or fingolimod or within BRACETD. Three-way-multinomial-propensity-score-matched cohorts were identified, and comparisons between treatment groups were conducted for annualised relapse rate (ARR) and 6-month-confirmed disability worsening (CDW6M) and improvement (CDI6M). Results were applied in a cost-effectiveness model over a lifetime horizon using a published Markov structure with health states based on the Expanded Disability Status Scale. Other model parameters were obtained from the UK MS Survey 2015, published literature, and publicly available UK sources. RESULTS: The MSBase analysis found a significant reduction in ARR (rate ratio [RR] = 0.64; 95% confidence interval [CI] 0.57-0.72; p < 0.001) and an increase in CDI6M (hazard ratio [HR] = 1.67; 95% CI 1.30-2.15; p < 0.001...