Abstract
Background
Fingolimod is a once-daily orally administered disease-modifying therapy (DMT) indicated
for treatment of relapsing forms of multiple sclerosis (MS) to reduce the frequency
of clinical relapses and delay accumulation of physical disability. In the randomized,
double-blind, phase 3 TRANSFORMS trial, 0.5 mg/d oral fingolimod substantially reduced
relapse frequency when compared with IM interferon-β1a (IFN-β1a) at 12-months. In
a 12-month, double-blind, extension phase of the TRANSFORMS study, patients assigned
to receive fingolimod continued to receive the same dosage, whereas patients who originally
received IM IFN-β1a were randomized to receive either 0.5 or 1.25 mg/d fingolimod.
Objective
To investigate the cost-effectiveness of initiating fingolimod therapy early versus
after 1 year of IFN-β1a therapy using TRANSFORMS study extension data.
Methods
A Microsoft Excel-based model was used to calculate the cost per relapse avoided for
2 years with continuous treatment with fingolimod compared with first-year treatment
with IM IFN-β1a and second-year treatment with fingolimod. One-way sensitivity analyses
were conducted on key input variables to assess their effect on cost per relapse avoided.
Results
The 2-year relapse rate in the early fingolimod arm was 0.23, and in the delayed fingolimod
arm was 0.53. The cost per relapse avoided was $83,125 in the early fingolimod arm
versus $103,624 in the delayed fingolimod arm. Results of the sensitivity analyses
showed an effect of drug acquisition cost and number of relapses in patients who received
no treatment.
Conclusion
Continuous treatment with fingolimod for 2 years resulted in a lower cost per relapse
avoided compared with treatment with IM IFN-β1a for the first year and then switching
to fingolimod therapy. Thus, delaying fingolimod therapy does not seem to be cost
effective.
Key words
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Article info
Publication history
Published online: July 02, 2012
Accepted:
June 14,
2012
Identification
Copyright
© 2012 Elsevier HS Journals, Inc. Published by Elsevier Inc. All rights reserved.
