OBJECTIVES: Multiple sclerosis (MS) is a chronic immune mediated neurodegenerative disease of the central nervous system with US prevalence of ~900,000 and high economic burden. Medical care for MS involves high-cost diseases modifying therapies (DMT). The current study aims to compare the cost-effectiveness of best-selling biologics (Ocrelizumab, Natalizumab, Alemtuzumab) with best-selling chemical drugs (Dimethyl Fumarate, Fingolimod) as DMT for MS to support better clinical decision-making.

METHODS: A 20-state Markov model simulated MS patients’ health outcomes and costs to compare the cost-effectiveness of different DMT drugs within 20-year horizon from US societal perspective. Main parameters including costs, utilities, and transition matrix were obtained mainly from published network meta-analyses and observational studies. Model reported pairwise incremental cost-effectiveness ratio (ICER) and incremental net-monetary benefit (INMB) under $150,000 per quality-adjusted life-year (QALY) willingness-to-pay threshold. One-way and probabilistic sensitivity analyses were performed to test results’ robustness to parameter uncertainties.

RESULTS: In the base case, Alemtuzumab has the highest effectiveness (12.65 QALYs), followed by Ocrelizumab (12.48 QALYs), while Fingolimod generated highest cost ($2,547,715.24) and lowest effectiveness (13.92 QALYs). All Biologics dominated chemical drugs. Ocrelizumab dominated Natalizumab. ICER of Alemtuzumab compared with Ocrelizumab was $1,178,890.9 per QALY. No drug was cost-effective compared with supportive care, with ICER ranging from $513,827 (Alemtuzumab) to $1.273,034 (Fingolimod) per QALY. Model results were sensitive to parameter uncertainties in relative risks, drug acquisition costs, and health utilities with earlier disability stages.

CONCLUSIONS: Biologic drugs represent higher clinical and economic value compared to chemical drugs. Ocrelizumab is most cost-effective, followed by Alemtuzumab, Natalizumab, Dimethyl Fumarate, and Fingolimod. Ocrelizumab should be prioritized in clinical practice with economic considerations. However, no DMT is more cost-effective compared with supportive care due to high drug acquisition costs. Future policies should control DMT price to increase the economic value of DMT treatment.