Switching to Fingolimod or Interferon Beta-1a: A Cost-Effectiveness Analysis

Background: Self-injectable disease modifying therapies (DMTs) have shown efficacy in the treatment of relapsing-remitting multiple sclerosis (RRMS). However, a number of patients continue to experience treatment failure despite being on these DMTs. Fingolimod, a sphingosine-1 phosphate receptor modulator, has shown higher efficacy in reducing relapse rates compared to placebo and an active comparator. In a 12-month, head-to-head, double-blind, double-dummy, Phase 3 study (TRANSFORMS), oral fingolimod 0.5 mg was shown to significantly reduce relapse frequency compared with intramuscular (IM) interferon-beta (IFNβ-1a).

Objectives: To examine the cost-effectiveness of switching patients with RRMS previously treated with IFNβ or glatiramer acetate to fingolimod versus switching to IM IFNβ-1a from a US commercial health plan perspective.

Methods: A Microsoft® Excel-based model was used to calculate the cost per relapse avoided over a 1-year time period after switching to fingolimod or switching to IM IFNβ-1a from an IFNβ or glatiramer acetate. Annualized relapse rates (ARR) of previously treated patients switched to fingolimod and IM IFNβ-1a were included from previously published post-hoc analyses of TRANSFORMS. It was assumed that all previously-treated patients were switched due to treatment failure. One-way sensitivity analyses were performed on key input variables.

Results: The ARR of patients switching to fingolimod was 0.26, as opposed to 0.53 for patients switching to IM IFNβ-1a. The cost per relapse avoided was $119,056 in the “switch-to-fingolimod” group versus $226,144 in the “switch-to IM-IFNβ-1a” group. Sensitivity analyses showed that the cost per relapse avoided results were most sensitive to ARR of the untreated patient and relapse reduction on fingolimod.

Conclusions: Patients with MS who have recently failed self-injectable DMTs may obtain clinical and economic benefits by switching to fingolimod as opposed to switching to IM IFNβ-1a therapy. Switching to a higher efficacy DMT is more cost-effective compared to switching between self-injectable DMTs.