title: The cost-effectiveness of delayed-release dimethyl fumarate for the treatment of relapsing-remitting multiple sclerosis in Canada.
abstract: BACKGROUND
  Multiple sclerosis (MS) causes significant disability and diminished quality-of-life. Delayed-release dimethyl fumarate (DMF; also known as gastro-resistant DMF) is a new oral treatment for relapsing-remitting MS (RRMS) approved in the US, Australia, Canada, and Europe.
  
  
  OBJECTIVE
  A cost-effectiveness model was developed to compare the health economic impact of DMF against other disease-modifying therapies (DMTs) as first-line RRMS treatment from a Canadian Ministry of Health perspective.
  
  
  METHODS
  A Markov cohort model was developed to simulate patients' progression through health states based on the Kurtzke Expanded Disability Status Scale (EDSS) over a life-time horizon. Patients entered the model based on a distribution of baseline EDSS scores, from which they could progress to higher or regress to lower EDSS state, or remain in the same state. Relapses could occur at any EDSS score. Results from a mixed-treatment comparison were used to inform model inputs for disease progression and relapse rates per treatment. Costs included direct medical costs stratified by EDSS score. Utilities were accrued based on time spent in each EDSS state.
  
  
  RESULTS
  Compared with glatiramer acetate, DMF yielded 0.528 incremental quality-adjusted life-years (QALYs) at an incremental cost of $23 338 Canadian dollars (CAD), resulting in an incremental cost-effectiveness ratio (ICER) of CAD $44 118/QALY. The ICER for DMF compared with Rebif 44 mcg was CAD $10 672. Results were consistent across a wide range of one-way and probabilistic sensitivity analyses.
  
  
  CONCLUSIONS
  Based on traditional cost-effectiveness thresholds in Canada (CAD $50 000-60 000), DMF can be considered a cost-effective option compared to other first-line DMTs.
authors.affiliation: a Evidera , Bethesda , MD , USA ;
authors.forename: Wenqing
authors.initials: W
authors.lastname: Su
authors.affiliation: a Evidera , Bethesda , MD , USA ;
authors.forename: Anuraag
authors.initials: A
authors.lastname: Kansal
authors.affiliation: b PIVINA Consulting, Inc. , Ontario , Canada ;
authors.forename: Colin
authors.initials: C
authors.lastname: Vicente
authors.affiliation: c Biogen , Cambridge , MA , USA.
authors.forename: Baris
authors.initials: B
authors.lastname: Deniz
authors.affiliation: c Biogen , Cambridge , MA , USA.
authors.forename: Sujata
authors.initials: S
authors.lastname: Sarda
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations; D000069462:Dimethyl Fumarate / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D000068717:Glatiramer Acetate / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use*; D000068556:Interferon beta-1a / Q000191:economics; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
chemical_list: D003692:Delayed-Action Preparations; D007166:Immunosuppressive Agents; D000068717:Glatiramer Acetate; D000069462:Dimethyl Fumarate; D000068556:Interferon beta-1a
keywords: Canada; Cost effectiveness; Dimethyl fumarate; Multiple sclerosis; QALY