%0 Journal Article
%T Benefits of early highly effective versus escalation treatment strategies in relapsing multiple sclerosis estimated using a treatment-sequence model.
%A Smets I
%A Versteegh M
%A Huygens S
%A Wokke B
%A Smolders J
%J Mult Scler
%V 30
%N 8
%D 2024 Jul 10
%M 38859625
%F 5.855
%R 10.1177/13524585241258692
%X <B>UNASSIGNED: </B>Uncertainty about disproportionate impact on health care budgets limits implementation of early highly effective treatment (EHT) in multiple sclerosis (MS).<BR><B>UNASSIGNED: </B>To estimate cost-effectiveness of escalation versus EHT disease-modifying treatment (DMT) sequences.<BR><B>UNASSIGNED: </B>Using a health-economic approach, we analysed health benefits (relapse rate reduction, disability prevention), direct/indirect DMT and societal costs of escalation versus EHT DMT sequences. In scenario analyses, we allowed (1) earlier use of alemtuzumab (ALE) and (2) a single retreatment with cladribine (CLA).<BR><B>UNASSIGNED: </B>In our model, we showed that the ratio between costs and quality-adjusted life years (QALYs) for the most cost-effective EHT and escalation sequence results into a similar net health benefit with higher costs and also higher QALYs associated with an EHT versus escalation strategy. Earlier use of ALE is more cost-effective than in later lines, even when aggravating the impact of its side-effects tenfold. Retreatment with CLA was more cost-effective in both escalation and EHT sequences.<BR><B>UNASSIGNED: </B>Certain EHT sequences are equally cost-effective to escalation sequences and are likely to result in more health at uncertain additional costs. The favourable cost-benefit ratio of CLA and ALE suggests that a wider application of affordable highly effective therapies could promote the cost-effectiveness both EHT and escalation approaches.