OBJECTIVES:

Ocrelizumab represents a generally well-tolerated, high-efficacy disease-modifying therapy (DMT) approved in Czech Republic for the RRMS. The aim of this study was to evaluate the cost-effectiveness of ocrelizumab compared with other DMT (glatiramer acetate, interferon beta-1a, interferon beta-1b, teriflunomide) for the treatment of RRMS from payer perspective.

METHODS:

A 1-year cycle cohort-based multi-state Markov model using Expand Disability Status Scale (EDSS) health states was developed. Two key clinical manifestations are reported in RRMS, an exacerbation of symptoms (known as relapses) and progressing disability over time based on EDSS. The probability of changing EDSS state or experiencing a relapse was determined by natural history data as well as conversion from RRMS to SPMS. Treatments were assumed to delay the progression of disease and reduce the frequency of relapses in RRMS; by applying a treatment effect to natural history data. Specific all-cause discontinuation rate for each DMT were used for transition into lateral switch or escalation therapy in comparator arm. Probability of being treated with other DMT or escalation as well as therapy structure was derived from local clinical registry ReMuS. Treatment effects, annual relapse rate, confirmed disability progression and all-cause discontinuation rates were taken from NMA. Patient utilities were sourced from literature. Discount rate 3% for costs and outcomes, half cycle correction and lifetime horizon was applied. Treatment was discontinued if EDDS achieved 7.

RESULTS:

Compared to comparators, ocrelizumab was associated with a delay in progression, resulting in a gain of 0.82 – 1.12 QALYs and incremental cost in range of $58,074 - $81,637 corresponding with ICER in range of $61,103 - $67,132.

CONCLUSIONS:

Treatment of RRMS with ocrelizumab was more costly and more effective than DMT. Ocrelizumab was not cost-effective on the applied threshold level of approx. $51,000 with official price. Hence, patient access scheme was introduced to provide access to patients in Czech Republic.