Cost-effectiveness of Teriflunomide Compared to Interferon Beta-1b for Relapsing Multiple Sclerosis Patients in China

Abstract

Background and Objective Teriflunomide is a once-daily oral immunomodulatory agent approved in 80 countries for the treatment of patients with relapsing multiple sclerosis (RMS). The study objective was to estimate the cost effectiveness of teriflunomide (14 mg tablet, daily) versus interferon beta-1b (250 mcg subcutaneous injection, every other day) among RMS patients from the Chinese healthcare system perspective. Methods A Markov model with annual cycles and a lifetime horizon was utilized to assess cost-effectiveness of teriflunomide in comparison with interferon beta-1b in RMS patients. Treatment effects, including 3-month confirmed disability worsening and annualized relapse rate, were derived from a network meta-analysis. Cost inputs included costs related to treatment acquisition, administration, monitoring, natural disease management through Expanded Disability Status Scale states, relapse treatment, and adverse event management. These costs were calculated as the product between unit costs from published sources and healthcare resource utilization patterns identified in a survey conducted among 11 neurologists across different areas in China. Health effects were expressed as quality-adjusted life years (QALYs) with costs in local currency (¥) and US dollars (US$), 2018. Results Teriflunomide dominated interferon beta-1b and was associated with lower total costs (teriflunomide ¥1,887,144 vs interferon beta-1b ¥2,061,393) and higher QALYs (teriflunomide 9.60 QALYs vs interferon beta-1b 8.88 QALYs). In probabilistic sensitivity analysis, teriflunomide was dominant in 62.2% of model runs. Conclusion Teriflunomide is a cost-effective therapy over a lifetime time horizon compared to interferon beta-1b in the treatment of RMS patients in China. Results should be interpreted with caution as head-to-head comparisons are not available. Electronic supplementary material The online version of this article (10.1007/s40261-019-00750-3) contains supplementary material, which is available to authorized users.

How have Economic Evaluations in Relapsing Multiple Sclerosis Evolved Over Time? A Systematic Literature Review

“…Overall, the most common source of the natural history data was the London Ontario data set ( n = 33). Another source was the British Columbia data set, which was sourced by 13 studies [ 42 , 46 , 77 , 78 , 119 – 121 , 124 , 144 , 151 – 154 ]. Among these, four studies [ 42 , 119 , 144 , 152 ] coupled the data with the London Ontario data set, seven studies supplemented the London Ontario data set with a Sweden registry data set, three of which were US studies [ 71 , 137 , 155 ], while the remaining were studies from Europe ( n = 2) [ 50 , 76 ] and Iran ( n = 2) [ 43 , 156 ].…”

“…In the seven-state Markov model, the EDSS state was grouped into few limitations in mobility (EDSS 0.0-2.5), moderate limitations in mobility (EDSS 3.0-5.5), walking aid or wheelchair required (EDSS 6.0-7.5), restricted to bed (EDSS 8.0-9.5), and death (EDSS 10 or natural causes of death). Nine studies [47,78,[119][120][121][122][123][124][125] and three HTA reports [88,97,103] constructed models consisting of 11 health states: ten EDSS states per the EDSS (EDSS 0-9) and one death state. The remaining studies had a Markov model in which the number of states varied between three and 21.…”

Cost-Effectiveness of Teriflunomide and Fingolimod in The First-Line Treatment of Relapsing-Remitting Multiple sclerosis：The Chinese Health System Perspective

“…At the same time, this study also set up a drug withdrawal mechanism and second-line treatment with natalizumab after drug withdrawal, so that the results are closer to the real situation. Yan Xu et al [23] . conducted a cost-effect analysis of teri unomide and IFN-β1a from the perspective of Chinese medical care, and found that teri unomide has a lower cost and a higher effect, compared to IFNβ-1a.…”

“…The probability is 82%, and the probability that recurrence does not lead to hospitalization is about 18%. At the same time, adverse reactions will also lead to a decrease in the annual utility value [23] . (Table 2)…”

The Clinical Effectiveness and Cost-Effectiveness of Rituximab Versus Natalizumab in Patients With Relapsing Remitting Multiple Sclerosis

“…The time horizon in this study was the lifespan and the interval of the annual Markov cycles. For each one-year cycle in the model, the patients remained in their current states or were transferred to other ones, and any patient might experience relapse or death (23,24). All the probabilities of transition to other states, Annualized Relapse Rate, and the probability of death in each Expanded Disability Status Scale (EDSS) were extracted based on previously published studies and were presented in Table 1 1 (25)(26)(27)(28).…”