{Reference Type}: Journal Article
{Title}: Benefits of early highly effective versus escalation treatment strategies in relapsing multiple sclerosis estimated using a treatment-sequence model.
{Author}: Smets I;Versteegh M;Huygens S;Wokke B;Smolders J;
{Journal}: Mult Scler
{Volume}: 30
{Issue}: 8
{Year}: 2024 Jul 10
{Factor}: 5.855
{DOI}: 10.1177/13524585241258692
{Abstract}: UNASSIGNED: Uncertainty about disproportionate impact on health care budgets limits implementation of early highly effective treatment (EHT) in multiple sclerosis (MS).
UNASSIGNED: To estimate cost-effectiveness of escalation versus EHT disease-modifying treatment (DMT) sequences.
UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: 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.