PMID- 28635362
OWN - NLM
STAT- MEDLINE
DCOM- 20180521
LR  - 20180521
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 20
IP  - 9
DP  - 2017 Sep
TI  - Costs and effectiveness of fingolimod versus alemtuzumab in the treatment of 
      highly active relapsing-remitting multiple sclerosis in the UK: re-treatment, 
      discount, and disutility.
PG  - 962-973
LID - 10.1080/13696998.2017.1345748 [doi]
AB  - OBJECTIVE: Patients with relapsing-remitting multiple sclerosis (RRMS) treated 
      with disease modifying therapies (DMTs) who continue to experience disease 
      activity may be considered for escalation therapies such as fingolimod, or may be 
      considered for alemtuzumab. Previous economic modeling used Markov models; 
      applying one alternative technique, discrete event simulation (DES) modeling, 
      allows re-treatment and long-term adverse events (AEs) to be included in the 
      analysis. METHODS: A DES was adapted to model relapse-triggered re-treatment with 
      alemtuzumab and the effect of including ongoing quality-adjusted life year (QALY) 
      decrements for AEs that extend beyond previous 1-year Markov cycles. As the price 
      to the NHS of fingolimod in the UK is unknown, due to a confidential patient 
      access scheme (PAS), a variety of possible discounts were tested. The interaction 
      of re-treatment assumptions for alemtuzumab with the possible discounts for 
      fingolimod was tested to determine which DMT resulted in lower lifetime costs. 
      The lifetime QALY results were derived from modeled treatment effect and short- 
      and long-term AEs. RESULTS: Most permutations of fingolimod PAS discount and 
      alemtuzumab re-treatment rate resulted in fingolimod being less costly than 
      alemtuzumab. As the percentage of patients who are re-treated with alemtuzumab 
      due to experiencing a relapse approaches 100% of those who relapse whilst on 
      treatment, the discount required for fingolimod to be less costly drops below 5%. 
      Consideration of treatment effect alone found alemtuzumab generated 0.2 more 
      QALYs/patient; the inclusion of AEs up to a duration of 1 year reduced this 
      advantage to only 0.14 QALYs/patient. Modeling AEs with a lifetime QALY decrement 
      found that both DMTs generated very similar QALYs with the difference only 0.04 
      QALYs/patient. CONCLUSIONS: When the model captured alemtuzumab re-treatment and 
      long-term AE decrements, it was found that fingolimod is cost-effective compared 
      to alemtuzumab, assuming application of only a modest level of confidential PAS 
      discount.
FAU - Montgomery, Stephen M
AU  - Montgomery SM
AUID- ORCID: 0000-0002-8481-5850
AD  - a Costello Medical Consulting Ltd , Cambridge , UK.
FAU - Kusel, Jeanette
AU  - Kusel J
AD  - a Costello Medical Consulting Ltd , Cambridge , UK.
FAU - Nicholas, Richard
AU  - Nicholas R
AD  - b Imperial College Healthcare NHS Trust, Charing Cross Hospital , London , UK.
FAU - Adlard, Nicholas
AU  - Adlard N
AD  - c Novartis Pharmaceuticals UK Ltd , Camberley, Surrey , UK.
LA  - eng
PT  - Journal Article
DEP - 20170711
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Immunosuppressive Agents)
RN  - 3A189DH42V (Alemtuzumab)
RN  - G926EC510T (Fingolimod Hydrochloride)
SB  - IM
MH  - Adult
MH  - Alemtuzumab/economics/*therapeutic use
MH  - Cost-Benefit Analysis
MH  - Female
MH  - Fingolimod Hydrochloride/economics/*therapeutic use
MH  - Health Expenditures
MH  - Humans
MH  - Immunosuppressive Agents/economics/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Models, Economic
MH  - Multiple Sclerosis, Relapsing-Remitting/*drug therapy
MH  - Prescription Fees
MH  - Quality-Adjusted Life Years
MH  - State Medicine
MH  - United Kingdom
OTO - NOTNLM
OT  - Multiple sclerosis
OT  - alemtuzumab
OT  - cost-effectiveness
OT  - cost-utility
OT  - fingolimod
OT  - highly active relapsing-remitting multiple sclerosis
EDAT- 2017/06/22 06:00
MHDA- 2018/05/22 06:00
CRDT- 2017/06/22 06:00
PHST- 2017/06/22 06:00 [pubmed]
PHST- 2018/05/22 06:00 [medline]
PHST- 2017/06/22 06:00 [entrez]
AID - 10.1080/13696998.2017.1345748 [doi]
PST - ppublish
SO  - J Med Econ. 2017 Sep;20(9):962-973. doi: 10.1080/13696998.2017.1345748. Epub 2017 
      Jul 11.