OBJECTIVES: Ofatumumab is a high-efficacy disease-modifying therapy (DMT) approved for first‑line treatment of relapsing-remitting Multiple Sclerosis (RRMS) with active disease in Canada. This study evaluated the costs and consequences of ofatumumab as an initial therapy versus other first-line and second-line DMTs and best supportive care (BSC), as well the impact of delayed treatment initiation with ofatumumab.

METHODS: A Markov cohort model was run over 10-years using an annual cycle length and 1.5% annual discount rate from the Canadian healthcare system perspective. A scenario analysis examined the impact of administering ofatumumab as a first-line therapy versus administering ofatumumab after 3 and 5 years of treatment with teriflunomide, dimethyl fumarate, glatiramer acetate, and Rebif 44.

RESULTS: Over 10‑years, ofatumumab resulted in a lower degree of disability, less relapse events (3.82), less disability-adjusted life years (2.30), and a decreased proportion of patients progressing to EDSS 7 or higher (14.62%) versus comparators. Treatment with comparators resulted in greater incremental administration and monitoring costs versus ofatumumab, except for glatiramer acetate (-$27) and cladribine (-$58); however, all comparators resulted in greater non-DMT costs versus ofatumumab. A greater percentage of patients with ofatumumab were employed (35.6%) and working full time (26.40%) at 10 years versus comparators. A scenario analysis revealed patients who switch to ofatumumab earlier (at 3 versus 5 years) after treatment with a commonly administered first-line DMT resulted in improved clinical and productivity outcomes, and decreased costs.

CONCLUSIONS: Ofatumumab resulted in improved clinical, economic, and productivity outcomes versus comparators, which highlights the value of a high efficacy DMT such as ofatumumab as an initial treatment (i.e. first-line option) in patients with RRMS with active disease. Of note, patients treated with ofatumumab earlier in the course of their disease achieved greater clinical outcomes and productivity, without additional costs, over 10-years compared with delayed treatment switching.