VOLUME 37 | ISSUE 6 | NOVEMBER-DECEMBER 2017

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Cost-effectiveness of oral agents in relapsing-remitting multiple sclerosis compared to interferon-based therapy in Saudi Arabia

Mai F. Alsaqa'aby,a Varun Vaidya,b Noura Khreis,a Thamer Al Khairallah,c Ahmed H. Al-jedaid

From the aPharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; bDepartment of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, Ohio, United States; cDepartment of Neurology, Neurosciences, King Faisal Specialist Hospital and Research Centre; dPharmacy Services, King Faisal Specialist Hospital and Research Centre, Riyadh Saudi Arabia

How to cite this article:

Alsaqa'aby MF, Vaidya V, Khreis N, Al Khairallah T, Al-jedai AH. Cost-effectiveness of oral agents in relapsing-remitting multiple sclerosis compared to interferon-based therapy in Saudi Arabia. Ann Saudi Med 2017; 37(6): 433-443. 

DOI: 10.5144/0256-4947.2017.433

Abstract

BACKGROUND: Promising clinical and humanistic outcomes are associated with the use of new oral agents in the treatment of relapsing-remitting multiple sclerosis (RRMS). This is the first cost-effectiveness study comparing these medications in Saudi Arabia.

 

OBJECTIVES: We aimed to compare the cost-effectiveness of fingolimod, teriflunomide, dimethyl fumarate, and interferon (IFN)-b1a products (Avonex and Rebif) as first-line therapies in the treatment of patients with RRMS from a Saudi payer perspective.

 

DESIGN: Cohort Simulation Model (Markov Model).

 

SETTING: Tertiary care hospital.

 

METHODS: A hypothetical cohort of 1000 RRMS Saudi patients was assumed to enter a Markov model model with a time horizon of 20 years and an annual cycle length. The model was developed based on an expanded disability status scale (EDSS) to evaluate the cost-effectiveness of the five disease-modifying drugs (DMDs) from a healthcare system perspective. Data on EDSS progression and relapse rates were obtained from the literature; cost data were obtained from King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. Results were expressed as incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMB) in Saudi Riyals and converted to equivalent $US. The base-case willingness-to-pay (WTP) threshold was assumed to be $100000 (SAR375000). One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to test the robustness of the model.

 

MAIN OUTCOME MEASURES: ICERs and NMB.

 

RESULTS: The base-case analysis results showed Rebif as the optimal therapy at a WTP threshold of $100000. Avonex had the lowest ICER value of $337282/QALY when compared to Rebif. One-way sensitivity analysis demonstrated that the results were sensitive to utility weights of health state three and four and the cost of Rebif.

 

CONCLUSION: None of the DMDs were found to be cost-effective in the treatment of RRMS at a WTP threshold of $100000 in this analysis. The DMDs would only be cost-effective at a WTP above $300000. 

 

LIMITATIONS: The current analysis did not reflect the Saudi population preference in valuation of health states and did not consider the societal perspective in terms of cost. 

 

 

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