title: Cost-effectiveness of fingolimod versus interferon beta-1a for relapsing remitting multiple sclerosis in the United States.
abstract: OBJECTIVE
  Fingolimod has been shown to be more efficacious than interferon (IFN) beta-1a, but at a higher drug acquisition cost. The aim of this study was to assess the cost-effectiveness of fingolimod compared to IFN beta-1a in patients diagnosed with relapsing-remitting multiple sclerosis (RRMS) in the US.
  
  
  METHODS
  A Markov model comparing fingolimod to intramuscular IFN beta-1a using a US societal perspective and a 10-year time horizon was developed. A cohort of 37-year-old patients with RRMS and a Kurtzke Expanded Disability Status Scale score of 0-2.5 were assumed. Data sources included the Trial Assessing Injectable Interferon vs FTY720 Oral in Relapsing-Remitting Multiple Sclerosis (TRANSFORMS) and other published studies of MS. Outcomes included costs in 2011 US dollars, quality-adjusted life years (QALYs), number of relapses avoided, and incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  Compared to IFN beta-1a, fingolimod was associated with fewer relapses (0.41 vs 0.73 per patient per year) and more QALYs gained (6.7663 vs 5.9503), but at a higher cost ($565,598 vs $505,234). This resulted in an ICER of $73,975 per QALY. Results were most sensitive to changes in drug costs and the disutility of receiving IFN beta-1a. Monte Carlo simulation demonstrated fingolimod was cost-effective in 35% and 70% of 10,000 iterations, assuming willingness-to-pay thresholds of $50,000 and $100,000 per QALY, respectively.
  
  
  CONCLUSIONS
  Event rates were primarily derived from a single randomized clinical trial with 1-year duration of follow-up and extrapolated to a 10-year time horizon. Comparison was made to only one disease-modifying drug-intramuscular IFN beta-1a.
  
  
  CONCLUSIONS
  Fingolimod use is not likely to be cost-effective compared to IFN beta-1a unless fingolimod cost falls below $3476 per month or a higher than normal willingness-to-pay threshold is accepted by decision-makers.
authors.affiliation: University of Connecticut School of Pharmacy, Storrs, CT, USA.
authors.forename: Soyon
authors.initials: S
authors.lastname: Lee
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Baxter
authors.forename: Brendan
authors.initials: B
authors.lastname: Limone
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Roberts
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D000068876:Fingolimod Hydrochloride; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D017059:Models, Econometric; D009010:Monte Carlo Method; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000191:economics; D011409:Propylene Glycols / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D013110:Sphingosine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D014481:United States
chemical_list: D007166:Immunosuppressive Agents; D011409:Propylene Glycols; D016899:Interferon-beta; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine; D000068556:Interferon beta-1a