Cost-effectiveness analysis of rituximab versus natalizumab in patients with relapsing remitting multiple sclerosis

Abstract

Introduction Multiple sclerosis (MS) is an inflammatory disease in which the myelin sheaths of the nerve cells in the brain and spinal cord, which are responsible for communication, are destroyed and cause physical signs and symptoms. According to studies, anti-CD20 monoclonal antibodies have significant results in the treatment of this disease. Thus, the aim of the present study was to determine the cost-effectiveness of rituximab against natalizumab in the patients with RRMS in southern Iran in 2020. Methods This is an economic evaluation including cost-effectiveness analysis in which the Markov model with a lifetime horizon was used. The study sample consisted of 120 patients randomly selected from among those referred to the MS Association and the Special Diseases Unit of Shiraz University of Medical Sciences. In this study, the costs were collected from a societal perspective, and the outcomes were obtained in the form of Quality Adjusted Life Years (QALY) and the mean relapse rate. The TreeAge pro 2020 and Excel 2016 software were used for data analysis. Results The comparative study of rituximab and natalizumab showed that the patients receiving rituximab had lower costs ($ 58,307.93 vs. $ 354,174.85) and more QALYs (7.77 vs. 7.65). In addition, the incidence of relapse by rituximab was lower compared to natalizumab (1.15 vs. 2.57). The probabilistic one-way sensitivity analysis showed the robustness of the results. The scatter plots also showed that rituximab was more cost-effective for the patients in 100% of the simulations for the threshold of < $ 37,641. Discussion and conclusion According to the results of this study, rituximab had higher cost-effectiveness than natalizumab. Therefore, it could be a priority for RRMS patients compared to natalizumab because it reduced treatment costs and increased effectiveness.

Real‐World Healthcare Cost Savings and Reduced Relapse Rate with Off‐Label Rituximab versus Disease‐Modifying Treatments Approved for Relapsing–Remitting Multiple Sclerosis: A Nationwide Cost‐Effectiveness Study

“…The only previous cost-effectiveness studies of rituximab in MS were two smaller observational studies from Saudi Arabia (including 146 and 93 patients, of which 12 and 26 were treated with rituximab, respectively) and 2 simulation studies from Iran and Thailand, respectively. [28][29][30][31] Although severely limited by their size or use of simulation instead of real-world data, the results were broadly in line with our findings. Additionally, a study by a US healthcare provider indirectly assessed the cost-effectiveness of rituximab as part of the evaluation of their MS treatment optimization program.…”

“…This is the first large cost‐effectiveness analysis of rituximab for MS using real‐world data. The only previous cost‐effectiveness studies of rituximab in MS were two smaller observational studies from Saudi Arabia (including 146 and 93 patients, of which 12 and 26 were treated with rituximab, respectively) and 2 simulation studies from Iran and Thailand, respectively 28–31 . Although severely limited by their size or use of simulation instead of real‐world data, the results were broadly in line with our findings.…”

Clinical and economic evaluations of natalizumab, rituximab, and ocrelizumab for the management of relapsing-remitting multiple sclerosis in Saudi Arabia

“…[ 30 , 31 ] Therefore, comparing the effectiveness rates and costs of different innovative DMTs, such as natalizumab, for the management of MS is essential to assess their incremental benefits vis-a-vis other cheaper alternatives, such as rituximab. [ 20 ] In this study, two commonly prescribed mAbs (e.g., natalizumab and rituximab) were compared concerning their effectiveness in preventing RRMS progression as defined by the formation of new lesions on MRI, clinical relapse, and disability progression using real-world data retrieved from two tertiary care centers in Saudi Arabia. Although natalizumab is costlier than rituximab and has a labeled indication for MS, this did not result in better effectiveness in most bootstrap cost effectiveness distributions.…”

“…[ 14 , 16 , 18 – 22 ] Although rituximab does not have a labeled indication for treating of RRMS, it has been widely used in different healthcare settings. [ 14 , 20 , 21 ] Moreover, it has shown comparable effectiveness and discontinuation rates to natalizumab. It has seemingly better long–term outcomes based on observational data from a single–center study in the United States (U.S.).…”

“…[ 23 ] In addition, rituximab has been shown to be more cost-effective than natalizumab in all of the simulations in a Markov–based model study that included 120 RRMS patients from Shiraz in Iran. [ 20 ] However, these studies were mainly based on observational data from a single center, limiting their results generalizability. On the other hand, ocrelizumab is a relatively new mAb that was approved by the USFDA in March 2017 and considered a better exit strategy for patients who failed natalizumab compared to other DMTs, such as fingolimod.…”