OBJECTIVES

Multiple sclerosis (MS) remains an uncurable disease that, regardless of the phenotype, is characterized by disability progression. Ocrelizumab – a recombinant humanized monoclonal antibody that selectively targets CD20 mainly expressed by B cells – has demonstrated significant clinical benefit for the treatment of relapsing (RMS) and primary progressive (PPMS) forms of MS. The aim of this study was to evaluate the clinical and economic impact of ocrelizumab versus currently available disease modifying therapies (DMT) in Portugal.

METHODS

Previously validated discrete-time Markov models for MS were adapted to model the impact of ocrelizumab versus current clinical practise across three populations: treatment naïve RRMS (versus IFNB-1a, dimethyl fumarate, glatiramer acetate and teriflunomide), treatment experienced RRMS (versus fingolimod, natalizumab) and PPMS (versus best supportive care). For both RRMS and PPMS, health states were defined according to the Expanded Disability Status Scale (EDSS). For RRMS, the model further captures the occurrence of relapses and the progression to secondary progressive multiple sclerosis (SPMS). A lifetime time-horizon and societal perspective were adopted. Quality of life and costs (direct and indirect) were retrieved from the literature or official publicly available sources. A discount rate of 5% was applied to both costs and effectiveness.

RESULTS

Overall, when compared to current clinical practice, it is estimated that ocrelizumab represents a dominant option, generating gains of 0.85 QALY and savings of 8,781€ on the mean total costs per patient during lifetime. Subpopulation analysis demonstrates a higher effectiveness for the treatment of naïve RRMS patients (1.05 incremental QALY) and a dominant (cost-saving) scenario for experienced RRMS patients.

CONCLUSIONS

Ocrelizumab has demonstrated to be an efficient alternative for the treatment of MS in Portugal, being expected to provide a clear clinical benefit and overall savings for the National Health Service.