Cost-Effectiveness of Diroximel Fumarate Compared to Other First-Line Treatments for Relapsing-Remitting Multiple Sclerosis in Spain

OBJECTIVES: Recent studies have demonstrated the efficacy of Diroximel fumarate (DRF) as a first-line treatment for Relapsing-Remitting Multiple Sclerosis (RRMS). Nevertheless, no updated cost-effectiveness analysis (CEA) comparing first-line treatments exists. This study aims to carry out a CEA for DRF compared to other first-line Disease-Modifying Therapies (DMT) from the perspective of the Spanish Health System

METHODS: An entire-life time horizon cost-effectiveness model has been developed with a Markov structure based on cohorts and following the ScHARR model, where DRF is compared to the rest of first-line DMTs (Interferons, Glatiramer acetate, Teriflunomide, Dimethyl Fumarate, Ozanimod and Ponesimod). The population included in the model are adult patients with active RRMS, likely to be treated with first-line therapies. Treatment efficacy data comes from an indirect comparison. The main outcome was the Incremental Cost-Effectiveness Ratio (ICER), calculated through Quality Adjusted Life Years (QALYs). Deterministic and probabilistic sensitivity analyses were also carried out.

RESULTS: The total direct lifetime cost per patient treated with DRF was €272,503, less expensive than the compared DMTs except Glatiramer acetate 20 mg (€ 271,235). DRF generates a QALY value of 6,232, which is higher than the compared DMTs. The ICERs show that DRF is dominant alternative or cost-effective over the first-line DMTs, with a higher probability of being cost-effective than the other treatments for a willingness to pay over €2,000.

CONCLUSIONS: DRF is cost-effective compared to the rest of the first-line DMTs, showing an increase in life years and QALYs.