Pnd64 - cost-effectiveness of cladribine tablets for treatment of rrms in the netherlands

Cladribine tablets have recently become available in the Netherlands for patients with relapsing remitting MS (RRMS). A network meta-analysis has indicated that cladribine tablets reduce the frequency and severity of relapses and delay disability progression compared to current standard of care. To evaluate the cost-effectiveness of cladribine tablets compared to alternative options in the treatment of RRMS patients with high disease activity (HDA) and patients with rapidly evolving severe (RES) MS, in the Netherlands. A Markov model was developed simulating costs and effects of RRMS treatment. For HDA, alemtuzumab and fingolimod were used as comparators; natalizumab was used for the RES sub-population. The analysis includes a full societal perspective, including indirect medical costs, productivity costs, costs for informal care and a value-of-information (VOI) analysis. For the HDA sub-population, treatment with cladribine tablets was the dominant strategy compared to alemtuzumab and fingolimod with respectively 50.9% and 98.2% probability of being cost-effective at a threshold of €50,000 per QALY gained and a net monetary benefit (NMB) of €3,860 and €150,255, respectively. For the RES sub-population, treatment with cladribine tablets dominated treatment with natalizumab with 94.1% probability of being cost-effective at a threshold of €50,000 per QALY gained and a NMB of €123,048. The probabilistic sensitivity analyses showed significant overlap in the credible intervals for total lifetime QALY outcomes and costs of cladribine and all relevant comparators. The population-level VOI amounts to €19,295,441. Treatment of RRMS with cladribine tablets is cost-effective versus alemtuzumab and fingolimod in HDA patients, and cost-effective versus natalizumab in RES patients compared with current standard of care in the Netherlands, at a QALY threshold of €50,000. Cladribine tablets was dominant in all base case analyses. The probabilistic sensitivity analyses outcomes indicated that outcomes for cladribine tablets versus the comparators are surrounded by uncertainty.