Comparing the Effectiveness and Cost of DMTs vs Ozanimod for MS Patients

Relapsing–remitting multiple sclerosis (RRMS) relapses, while often accompanied by recovery, can result in sustained disability, significantly impacting patients' quality of life and imposing a substantial economic burden. The economic burden of multiple sclerosis (MS) in the US is estimated to be around $85.4 billion annually, with a per capita annual medical cost for MS patients exceeding that of individuals without the condition by over $65,000. Introducing disease-modifying therapies (DMTs) has expanded the treatment options for RRMS over the past three decades, offering a means to reduce relapse rates, delay disease progression, and potentially lower the overall cost of care. However, the lifelong management of MS and the high cost of existing DMTs remain challenges, alongside differences in dosing, administration, and side effects that affect patient tolerance and adherence, according to a study published in Neurology and Therapy.

Ozanimod, a newly approved oral DMT introduced in 2020, has shown promise as a treatment for RRMS. It operates as a sphingosine 1-phosphate (S1P) receptor modulator, effectively inhibiting immune cell migration to the central nervous system. A network meta-analysis (NMA) comparing ozanimod to other first-line oral and injectable DMTs revealed that ozanimod significantly reduced the annualized relapse rate (ARR) compared to some competitors, such as interferon beta-1a, interferon beta-1b, glatiramer acetate, and teriflunomide, and showed similar efficacy to dimethyl fumarate and fingolimod. Furthermore, ozanimod demonstrated comparable safety profiles regarding adverse events (AEs) and serious AEs (SAEs).

This study aimed to evaluate the cost-effectiveness of ozanimod compared to other commonly used oral and injectable DMTs for RRMS in the US. It employed various measures, including incremental drug costs per relapse avoided, MS-related health care costs per relapse avoided, and cost savings associated with preventing relapses and AEs with ozanimod versus comparator DMTs over one year. The analysis used data from the NMA and the number needed to treat (NNT) analyses, drug cost information from the Red Book, and health care cost data from targeted literature reviews and databases.

Findings showed that ozanimod had lower annual drug costs per person than many other DMTs, making it more cost-effective in terms of drug costs per relapse avoided. Furthermore, ozanimod was associated with lower total annual MS-related health care costs, further contributing to its cost-effectiveness when measured in terms of avoided health care costs per relapse. The analysis also highlighted that ozanimod could lead to annual health care cost savings ranging from $2,178 to $8,257 per patient, depending on the comparator DMT, when considering a fixed budget of $1 million for RRMS treatment.

This study had several limitations, such as relying on indirect evidence from NMAs due to a lack of head-to-head comparisons between DMTs and assumptions in estimating AE costs and the study's focus on clinical outcomes (rather than patient-reported outcomes), that are worth noting. However, researchers suggest treatment outcomes for ozanimod show the cost reductions that patients seek.

"Compared with all other DMTs evaluated, treatment with ozanimod was associated with reductions in annual drug and total annual MS-related health care costs to avoid relapses in patients with RRMS; these reductions were significant versus glatiramer acetate (20 mg), teriflunomide (7 mg and 14 mg), interferon beta-1b (250 μg; annual drug costs only), and interferon beta-1a (30 μg and 44 μg)," said researchers.

Reference

Kantor D, Pham T, Patterson-Lomba O, et al. Cost per relapse avoided for ozanimod versus other selected disease-modifying therapies for relapsing–remitting multiple sclerosis in the United States. Neurology and Therapy. 2023;12(3):849-861. doi:10.1007/s40120-023-00463-y