title: Cost effectiveness of fingolimod, teriflunomide, dimethyl fumarate and intramuscular interferon-β1a in relapsing-remitting multiple sclerosis.
abstract: OBJECTIVE
  The aim of the study was to compare the cost effectiveness of fingolimod, teriflunomide, dimethyl fumarate, and intramuscular (IM) interferon (IFN)-β(1a) as first-line therapies in the treatment of patients with relapsing-remitting multiple sclerosis (RRMS).
  
  
  METHODS
  A Markov model was developed to evaluate the cost effectiveness of disease-modifying drugs (DMDs) from a US societal perspective. The time horizon in the base case was 5 years. The primary outcome was incremental net monetary benefit (INMB), and the secondary outcome was incremental cost-effectiveness ratio (ICER). The base case INMB willingness-to-pay (WTP) threshold was assumed to be US$150,000 per quality-adjusted life year (QALY), and the costs were in 2012 US dollars. One-way sensitivity analyses and probabilistic sensitivity analysis were conducted to test the robustness of the model results.
  
  
  RESULTS
  Dimethyl fumarate dominated all other therapies over the range of WTPs, from US$0 to US$180,000. Compared with IM IFN-β(1a), at a WTP of US$150,000, INMBs were estimated at US$36,567, US$49,780, and US$80,611 for fingolimod, teriflunomide, and dimethyl fumarate, respectively. The ICER of fingolimod versus teriflunomide was US$3,201,672. One-way sensitivity analyses demonstrated the model results were sensitive to the acquisition costs of DMDs and the time horizon, but in most scenarios, cost-effectiveness rankings remained stable. Probabilistic sensitivity analysis showed that for more than 90% of the simulations, dimethyl fumarate was the optimal therapy across all WTP values.
  
  
  CONCLUSIONS
  The three oral therapies were favored in the cost-effectiveness analysis. Of the four DMDs, dimethyl fumarate was a dominant therapy to manage RRMS. Apart from dimethyl fumarate, teriflunomide was the most cost-effective therapy compared with IM IFN-β(1a), with an ICER of US$7,115.
authors.affiliation: Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, University Park Campus, VPD 214-L, Los Angeles, CA, 90089-3333, USA.
authors.forename: Xinke
authors.initials: X
authors.lastname: Zhang
authors.forename: Joel W
authors.initials: JW
authors.lastname: Hay
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Niu
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D000069462:Dimethyl Fumarate; D004185:Disability Evaluation; D005260:Female; D000068876:Fingolimod Hydrochloride; D005650:Fumarates / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000191:economics* / Q000627:therapeutic use*; D007273:Injections, Intramuscular; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000191:economics*; D011409:Propylene Glycols / Q000191:economics / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013110:Sphingosine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D005650:Fumarates; D007155:Immunologic Factors; D011409:Propylene Glycols; D016899:Interferon-beta; D000069462:Dimethyl Fumarate; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine; D000068556:Interferon beta-1a