Cost-Effectiveness of Alemtuzumab for Relapsing-Remitting Multiple Sclerosis

Background: Alemtuzumab has been shown to significantly reduce the rate of sustained accumulation of disability, improve disability scores and reduce the rate of relapse compared to interferon (IFN) beta-1a, though likely at a higher drug acquisition cost.

Objectives: To assess the cost-effectiveness of alemtuzumab compared to IFN beta-1a in patients diagnosed with relapsing-remitting MS (RRMS) in the United States (US) over the clinical trial period.

Methods: A Markov model was developed using data from the Comparison of Alemtuzumab and Rebif in Multiple Sclerosis I (CARE-MS I) and CARE-MS II trials, as well as other published studies of MS. Alemtuzumab (initiated at 12mg administered intravenously once daily for 5 consecutive days, then 12 mg for 3 consecutive days at 12-months) compared to IFN beta-1a (44mcg administered subcutaneously 3-times per week) was modeled over a 2-year time horizon assuming a cohort of 35-year-old (disease-modifying drug treatment-naïve or experienced) RRMS patients, 50% having a Kurtzke Expanded Disability Status Scale (EDSS) score or 2 and 50% a score of 3. The analysis was conducted from a US societal prospective using a 3-month cycle length. Costs incorporated into the model included drug acquisition costs, direct costs (outpatient and inpatient care, management of relapse, informal care and symptomatic management) and indirect costs (lost worker productivity) associated with each EDSS health state. Outcomes included costs (in 2012 US$), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analyses and Monte Carlo Simulation (MCS) were conducted to evaluate model uncertainty.

Results: Alemtuzumab was associated with more QALYs (1.27 vs. 1.04) but at a higher total treatment cost ($121,985 vs. $111,905) as compared to IFN beta-1a; resulting in an ICER=$43,826/QALY gained. Results were most sensitive to changes in drug acquisition costs for both medications and in the disutility of receiving IFN beta-1a. Alemtuzumab was cost-effective if the annual cost was <$39,120, the annual cost of IFN beta-1a was >$37,484, or the disutility of receiving IFN beta-1a was >0.0246. MCS suggested alemtuzumab was cost-effective in 48% and 59% of 10,000 iterations, assuming willingness to pay thresholds of $50,000 and $100,000/QALY, respectively.

Conclusions: Results of this trial-length analysis suggest that alemtuzumab is a cost-effective strategy compared to IFN beta-1a for treating patients with RRMS patients even when not extrapolated to longer time horizons.