RESUMO
OBJECTIVES: Multiple sclerosis (MS) is a degenerative neurological disorder. Treatment aims to avoid relapses and disability progression. The purpose of this study was to evaluate the cost-effectiveness of natalizumab compared with fingolimod for treating highly active relapsing-remitting MS (RRMS) patients from the Colombian third-party payer perspective. METHODS: We used a Markov economic model from the perspective of the Colombian healthcare system to estimate the cost-effectiveness of natalizumab compared with fingolimod for RRMS with high disease activity or failure of interferons as first-line therapy. This model was centered on disability progression and relapses. We considered a 5-year time horizon with a 5% discount rate. We included only direct medical costs. Local experts were consulted to obtain resource utilization estimates, and local standardized costing methodologies and sources were used. Outcome was considered in terms of quality-adjusted life-years (QALYs). Utilities were extracted or calculated from the literature. Transition probabilities were calculated from available efficacy and safety information (1 USD = 3050.98 COP). RESULTS: Natalizumab showed lower total costs (USD 80 024 vs USD 98 137) and higher QALY yield (3.01 vs 2.94) than fingolimod, dominating it (incremental cost-effectiveness ratio = -$1861). Univariate sensitivity analysis showcased the relevance of the measures of effect on disability progression for natalizumab on model results. Probabilistic sensitivity analysis replicated base-case results in most simulations. CONCLUSIONS: This study showed that natalizumab dominated fingolimod with lower costs and higher QALYs in patients with high-activity RRMS. These results are consistent with previous published international literature.
Assuntos
Cloridrato de Fingolimode/economia , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Natalizumab/economia , Colômbia/epidemiologia , Efeitos Psicossociais da Doença , Análise Custo-Benefício/métodos , Análise Custo-Benefício/estatística & dados numéricos , Cloridrato de Fingolimode/uso terapêutico , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Fatores Imunológicos/economia , Fatores Imunológicos/uso terapêutico , Imunossupressores/economia , Imunossupressores/uso terapêutico , Cadeias de Markov , Esclerose Múltipla Recidivante-Remitente/epidemiologia , Natalizumab/uso terapêuticoRESUMO
BACKGROUND: There have been many studies on the cost of multiple sclerosis in countries with high prevalence, whereas in Latin America such analyses are few. Taking into consideration the burden of this disease and the high financial impact of treatment on the health care system, it is necessary to know the behavior of cost of illness. OBJECTIVES: To describe the direct costs associated with health care in patients with multiple sclerosis affiliated with a health insurer in Colombia. METHODS: An analysis of direct costs of disease was performed from the perspective of the third-party payer. A direct measurement from the technical costing "top-down" approach was used. Data were adjusted for inflation and expressed in 2014 US dollars. RESULTS: The average annual cost per patient for the country was $29,339 (2010), $20,956 (2011), $23,892 (2012), $24,148 (2013), and $22,688 (2014). Drug therapy represented 86.1% of the total cost. Between 2010 and 2013, interferons accounted for the largest proportion of the costs of drug treatment (98.5% to 53%), whereas fingolimod showed an increase and accounted for 47% in 2014. CONCLUSIONS: Medications account for the largest proportion of disease costs, with few variations in the last 5 years; nevertheless, the increase in the use of new pharmaceuticals poses a challenge to maintain the financial balance of health insurance.