Abstract
Background: In high-income countries, four anti-CD20 monoclonal antibodies (mAbs) are used or in the
pipeline for relapsing MS: ocrelizumab, ofatumumab (both registered), ublituximab (awaiting registration)
and rituximab (off-label). List prices differ significantly between registered and off-label drugs.
Objective: Comparing differences in benefits between anti-CD20 mAbs from a health-economic and societal perspective.
Methods: To reflect lifetime use of DMTs, we used a treatment-sequence model to compare ocrelizumab/
ofatumumab and eight other drug classes in terms of health (lifetime relapses, time to Expanded Disability
Status Scale [EDSS] 6, lifetime quality-adjusted life years) and cost-effectiveness (net health benefit). To
become cost-effective compared to ocrelizumab, we modelled the list price of ublituximab and desired
effect on EDSS progression of rituximab.
Results: Although drug sequences with ocrelizumab in first- and second-line were more cost-effective than
ofatumumab, our probabilistic analysis suggests this outcome was very uncertain. To be more cost-effective than ocrelizumab, ublituximab needs to be about 25% cheaper whilst rituximab needs to equal the
effect on disability progression seen with first-line treatments.
Conclusions: Our model showed no clear difference in cost-effectiveness between ocrelizumab and ofatumumab. Hence, prescribing the least costly anti-CD20 mAb can democratise MS care without a loss in
health benefits.
pipeline for relapsing MS: ocrelizumab, ofatumumab (both registered), ublituximab (awaiting registration)
and rituximab (off-label). List prices differ significantly between registered and off-label drugs.
Objective: Comparing differences in benefits between anti-CD20 mAbs from a health-economic and societal perspective.
Methods: To reflect lifetime use of DMTs, we used a treatment-sequence model to compare ocrelizumab/
ofatumumab and eight other drug classes in terms of health (lifetime relapses, time to Expanded Disability
Status Scale [EDSS] 6, lifetime quality-adjusted life years) and cost-effectiveness (net health benefit). To
become cost-effective compared to ocrelizumab, we modelled the list price of ublituximab and desired
effect on EDSS progression of rituximab.
Results: Although drug sequences with ocrelizumab in first- and second-line were more cost-effective than
ofatumumab, our probabilistic analysis suggests this outcome was very uncertain. To be more cost-effective than ocrelizumab, ublituximab needs to be about 25% cheaper whilst rituximab needs to equal the
effect on disability progression seen with first-line treatments.
Conclusions: Our model showed no clear difference in cost-effectiveness between ocrelizumab and ofatumumab. Hence, prescribing the least costly anti-CD20 mAb can democratise MS care without a loss in
health benefits.
| Original language | English |
|---|---|
| Journal | Multiple Sclerosis Journal - Experimental, Translational and Clinical |
| Volume | 9 |
| Issue number | 3 |
| Early online date | 24 Jul 2023 |
| DOIs | |
| Publication status | Published - 2023 |
Bibliographical note
Funding Information:The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: C.E.A.C. has received funding from the Dutch National MS Foundation. S.A.H. has received funding from Merck for MS-related research. M.M.V. has received funding from Merck for MS-related research.
Publisher Copyright:
© The Author(s), 2023.