title: Cost-Effectiveness of Treatments for Relapsing Remitting Multiple Sclerosis: A French Societal Perspective.
abstract: OBJECTIVE
  The paper aimed to estimate the incremental cost-effectiveness ratio (ICER) at the public published price for delayed-release dimethyl fumarate versus relevant Multiple Sclerosis disease-modifying therapies available in France in June 2015.
  
  
  METHODS
  The economic model was adapted to the French setting in accordance with the Haute Autorité de Santé guidelines using a model previously developed for NICE. A cohort of Relapsing Remitting Multiple Sclerosis patients was simulated over a 30-year time horizon. Twenty one health states were taken into account: Kurtzke Expanded Disability Status Scale (EDSS) 0-9 for Relapsing Remitting Multiple Sclerosis patients, EDSS 0-9 for Secondary Progressive Multiple Sclerosis patients, and death. Estimates of relative treatment efficacy were determined using a mixed-treatment comparison. Probabilities of events were derived from the dimethyl fumarate pivotal clinical trials and the London Ontario Dataset. Costs and utilities were extracted from the published literature from both the payer and societal perspectives. Univariate and probabilistic sensitivity analyses were performed to assess the robustness of the model results.
  
  
  RESULTS
  From both perspectives, dimethyl fumarate and interferon beta-1a (IFN beta-1a) 44 mcg were the two optimal treatments, as the other treatments (IFN beta-1a 30 mcg, IFN beta-1b 250 mcg, teriflunomide, glatiramer acetate, fingolimod) were dominated on the efficiency frontier. From the societal perspective, dimethyl fumarate versus IFN beta-1a 44 mcg incurred an incremental cost of €3,684 and an incremental quality-adjusted life year (QALY) of 0.281, corresponding to an ICER of €13,110/QALY.
  
  
  CONCLUSIONS
  Despite no reference threshold for France, dimethyl fumarate can be considered as a cost-effective option as it is on the efficiency frontier.
authors.affiliation: Real World Strategy and Analytics, Mapi Group, Paris, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Chevalier
authors.affiliation: Economie de Santé & Affaires Gouvernementales, Biogen France SAS, Nanterre, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chamoux
authors.affiliation: Economie de Santé & Affaires Gouvernementales, Biogen France SAS, Nanterre, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Hammès
authors.affiliation: Real World Strategy and Analytics, Mapi Group, Paris, France.
authors.forename: Annie
authors.initials: A
authors.lastname: Chicoye
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D000069462:Dimethyl Fumarate / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use*; D000068556:Interferon beta-1a / Q000191:economics / Q000627:therapeutic use; D008297:Male; D018803:Models, Economic; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D019057:Quality-Adjusted Life Years
chemical_list: D007166:Immunosuppressive Agents; D000069462:Dimethyl Fumarate; D000068556:Interferon beta-1a