Cost-Effectiveness of Repository Corticotropin Injection for the Treatment of Acute Exacerbations in Multiple Sclerosis.

BACKGROUND

Relapses are common among patients with multiple sclerosis (MS) despite treatment with disease-modifying therapies. Repository corticotropin injection (RCI, Acthar

METHODS

A Markov state-transition model compared outcomes (costs, relapses, remission, and utilities) with RCI versus PMP or IVIg for the acute exacerbations in MS. The model was developed from the United States (US) payer and societal perspectives over one to three years. Patients initiated on alternative therapies were evaluated in one-day increments for the first 30 days during treatment. The model assumes the natural history of MS after treatment in the first month, adjusting for the effect of treatment. Incremental cost-effectiveness ratios (ICERs) were estimated as cost per quality-adjusted life-year (QALY) gained. The uncertainty in model parameters was evaluated in probabilistic sensitivity analyses.

RESULTS

In the base case, RCI has an ICER of USD 42,078 per QALY compared to PMP over one year from the payer perspective and is dominant over two and three years; RCI is dominant compared to PMP from the societal perspective over all three years. Compared to IVIg, RCI is a dominant strategy from both payer and societal perspectives over all three years. Probabilistic sensitivity analysis supports the base case findings, suggesting that RCI may be cost-effective versus PMP and IVIg for acute exacerbations in MS.

CONCLUSION

RCI is a cost-effective alternative treatment for MS relapses compared to PMP and IVIg from the US payer and societal perspectives.

Informations de copyright

© 2021 Hunter et al.

Déclaration de conflit d'intérêts

GJW and JN are employees at Mallinckrodt Pharmaceuticals. JB and MP were paid consultants at Mallinckrodt Pharmaceuticals for the duration of the project. IC was a research collaborator for the duration of the study. SFH is a research collaborator and has received speaker honoraria, consulting agreements, and grant/research financial support from AbbVie, Acorda, Actelion, Adamas, Alkermes, Avanir, Bayer, Biogen Idec, Bristol Meyers Squibb, EMD Serono, Janssen-Actelion, Novartis, Osmotica, Mallinckrodt, Roche, Sanofi, Synthon, and Teva. All authors declare that they have no other conflicts of interest.