Cost-effectiveness Of Fingolimod Versus Teriflunomide For The Treatment Of Relapsing-remitting Multiple Sclerosis

Objective:The aim of this study was to assess the cost-effectiveness of fingolimod compared to teriflunomide in patients diagnosed with relapsing-remitting multiple sclerosis(RRMS),and supply scientific information to decision maker.Methods:A Markov health-state model was designed for economic evaluation of fingolimod and teriflunomide for the treatment of RRMS. The Markov model includes five health states which were EDSS 0-2.5、EDSS3-5.5、EDSS6-7.5、EDSS8-9.5 and death. Similar to previous MS models, we utilized a 1-month cycle length, assumed a 10-year time horizon. Transition probabilities, utility and drug acquisition costs were derived from the literature research. Effectiveness was measured in terms of MS relapses avoided using data from the FREEDOMS and TOWER trials for all patients with RRMS. Outcomes included the total costs, quality-adjusted life-years(QALYs) and cost-effectiveness ratio were gotten through the Roll Back analysis and Markov cohort simulation. One-way sensitivity analyse was conducted to assess uncertainty.Results:The analysis of roll back showed that, in patients with RRMS, the cost-effectiveness ratios(CERS) of treatment with fingolimod was $35,742/QALY, and$15,496/QALY for teriflunomide. Markov cohort simulation showed that the mean total costs and effectiveness of teriflunomide over this time were $110,328 and 7.12 QALYs.Compared to teriflunomide, fingolimod was associated with more costs($254,129 vs$110,328) and less QALYs gained(7.11 vs 7.12). As for the sensitivity analysis, the change of key parameters did not affect the model results.Conclusion:Teriflunomide dominates fingolimod in terms of incremental cost per QALY gained,as it is more effective and less costly. So teriflunomide is a cost-effective treatment option for patients with relapsing-remitting multiple sclerosis.