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.