title: Cost minimisation analysis of fingolimod vs natalizumab as a second line of treatment for relapsing-remitting multiple sclerosis.
abstract: BACKGROUND
  At present, there is a lack of economic assessments of second-line treatments for relapsing-recurring multiple sclerosis. The aim of this study was to compare the efficiency between fingolimod and natalizumab in Spain.
  
  
  METHODS
  A cost minimisation analysis model was developed for a 2-year horizon. The same relapse rate was applied to both treatment arms and the cost of resources was calculated using Spain's stipulated rates for 2012 in euros. The analysis was conducted from the perspective of Spain's national health system and an annual discount rate of 3% was applied to future costs. A sensitivity analysis was performed to validate the robustness of the model.
  
  
  RESULTS
  Indirect comparison of fingolimod with natalizumab revealed no significant differences (hazard ratio between 0.82 and 1.07). The total direct cost, considering a 2-year analytical horizon, a 7.5% discount stipulated by Royal Decree, and a mean annual relapse rate of 0.22, was € 40914.72 for fingolimod and € 45890.53 for natalizumab. Of the total direct costs that were analysed, the maximum cost savings derived from prescribing fingolimod prescription was € 4363.63, corresponding to lower administration and treatment maintenance costs. Based on the sensitivity analysis performed, fingolimod use was associated with average savings of 11% (range 3.1%-18.7%).
  
  
  CONCLUSIONS
  Fingolimod is more efficient than natalizumab as a second-line treatment option for relapsing-remitting multiple sclerosis and it generates savings for the Spanish national health system.
authors.affiliation: Departamento de Estadística, Universidad de Barcelona, Barcelona, España; Oblikue Consulting, Barcelona, España. Electronic address: carlos.crespo@oblikue.com.
authors.forename: C
authors.initials: C
authors.lastname: Crespo
authors.affiliation: Unidad de Esclerosis Múltiple, Hospital Universitario Virgen de la Macarena, Sevilla, España.
authors.forename: G
authors.initials: G
authors.lastname: Izquierdo
authors.affiliation: Departamento de Farmacología y Terapéutica Clínica, Facultad de Medicina, Universidad de Málaga, Málaga, España.
authors.forename: A
authors.initials: A
authors.lastname: García-Ruiz
authors.affiliation: Novartis Farmacéutica, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Granell
authors.affiliation: Oblikue Consulting, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Brosa
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000191:economics* / Q000627:therapeutic use*; D003363:Cost Control / Q000379:methods*; D016527:Drug Costs; D000068876:Fingolimod Hydrochloride; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000191:economics*; D000069442:Natalizumab; D011409:Propylene Glycols / Q000191:economics* / Q000627:therapeutic use*; D013030:Spain; D013110:Sphingosine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D000069442:Natalizumab; D011409:Propylene Glycols; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine
keywords: Cost minimisation analysis; Efficiency; Eficiencia; Esclerosis múltiple remitente-recurrente; España; Fingolimod; Minimización costes; Natalizumab; Relapsing-remitting multiple sclerosis; Spain