Disease modifying treatments for relapsing remitting multiple sclerosis. A health economic evaluation

Hagen G, Lund UH, Fretheim A, Hamidi V.
Record ID 32018000775
Authors' objectives: The Norwegian Institute of Public health has previously assessed the efficacy, safety and cost effectiveness of drugs for relapsing remitting multiple sclerosis. In this report, three new drugs (cladribine, ocrelizumab and rituximab) are included. Effectiveness, safety and legal aspects are reported in a separate publication, as is ethical considerations. This report assesses the included drugs in light of the Norwegian priority setting criteria (benefit, resource use and disease severity).
Authors' results and conclusions: Relapsing remitting multiple sclerosis is a very severe disease, with an estimated absolute shortfall of 32 undiscounted quality adjusted life years (QALYs). In terms of health benefits, ocrelizumab is the treatment alternative that generates most health benefits (QALYs), while glatiramer acetate (40mg) generates the least. Ranked according to decreasing health benefits, ocrelizumab, alemtuzumab, natalizumab, rituximab, dimethyl fumerate, fingolimod, cladribine, teriflunomide, glatiramer acetate (20 mg) og glatiramer acetate (40mg) generate respectively 8.29, 8.27, 8.15, 8.14, 8.11, 7.95, 7.92, 7.79, 7.65 and 7.36 discounted QALYs. Some of the differences between the treatments are large compared to what is common in other disease areas. In terms of resource use over a 20 year time period, applying a broad healthcare perspective, natalizumab generates most costs and rituximab least costs based on net prices. Ranked by increasing cost, rituximab, cladribine, alemtuzumab, glatiramer acetate (20 mg), teriflunomide, glatiramer acetate (40mg), dimethyl fumerate, ocrelizumab, fingolimod and natalizumab generate respectively discounted NOK ████████████████████████████████████████████ and ██████████████████████ (exempt from public disclosure) based on net prices. Rituximab is more effective and less costly than cladribine (i.e. a dominant treatment strategy). Compared to alemtuzumab, rituximab is less effective, but also less costly. Ocrelizumab generates more health and more cost than cladribine, alemtuzumab and rituximab. Whether or not ocrelizumab can be considered a cost effective alternative, depend on assumed threshold value for cost effectiveness.
Project Status: Completed
Year Published: 2019
English language abstract: An English language summary is available
Publication Type: Full HTA
Country: Norway
MeSH Terms
  • Multiple Sclerosis
  • Multiple Sclerosis, Chronic Progressive
  • Fingolimod Hydrochloride
  • Rituximab
  • Systematic Review
  • Technology Assessment, Biomedical
  • Comparative Effectiveness Research
  • Multiple Sclerosis, Relapsing-Remitting
  • Cost-Benefit Analysis
  • Drug Therapy
  • Multiple Sclerosis
  • Chronic Progressive;
  • Fingolimod Hydrochloride;
  • Rituximab;
  • Systematic Review;
  • Technology Assessment
  • Biomedical;
  • Comparative Effectiveness Research;
Organisation Name: Norwegian Institute of Public Health
Contact Address: P.O. Box 222 Skoyen, N-0123, Oslo
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.