OBJECTIVES

Recently, dimethyl fumarate (DMF) was added to the therapeutic arsenal against Multiple Sclerosis (MS), but the cost-consequence of this drug versus other first-line disease-modifying therapies (i.e. injectable immunomodulatory drugs (IID) and two other oral drugs: fingolimod (FTY) and teriflunomide (TERI)) has never been studied in real world settings using data of a national claims database

METHODS

A cost–consequence analysis was performed for all patients identified in the French national claims database (SNDS), who initiated DMF, IID, TERI or FTY between 2015 and 2017, with 1 to 3.5 years of follow-up. DMF effectiveness compared to other treatment groups was assessed during the index treatment period by estimating the annual rate of relapses (ARR). Results were expressed in Relative Risk (RR). The annual costs of all reimbursed healthcare expenditures were compared between DMF and each of the other treatment groups from the healthcare system perspective, overall and by cost components (inpatient, medication and non-medication costs).

RESULTS

DMF proved to be significantly effective on ARR in comparison with IID and TERI (RR: 0.72 and 0.81, respectively). No significant difference was found with FTY, but the specific indication of FTY makes the comparison difficult. The mean overall cost per person-year for DMF was significantly higher than for TERI (14531€ vs. 13197€) and IID (14273 € vs. 12476€), this additional cost being mainly due to the medication costs (10352€ vs. 8640€ and 10274€ vs. 8130€, respectively for each treatment group). However, inpatients costs were significantly lower for DMF than for TERI (871€ vs. 1021€) and for IID (876€ vs. 1010€). In comparison to FTY, overall costs were significantly lower for DMF (15575€ vs. 24206€).

CONCLUSIONS

Compared to TERI and IID, DMF is an effective treatment strategy in reducing relapse occurrence in MS patients, which nevertheless entails an additional cost for the French healthcare system.