National Social Security Funds, Beirut, Lebanon.
American University of Beirut Medical Center, Beirut, Lebanon.
Mult Scler Relat Disord. 2022 Nov;67:104169. doi: 10.1016/j.msard.2022.104169. Epub 2022 Sep 9.
Cladribine tablets are a newly launched short course oral treatment approved for high disease activity (HDA) relapsing multiple sclerosis (RMS). The current analysis assessed the cost-utility and budgetary impact of introducing cladribine tablets in HDA-RMS patients compared with other HDA-RMS therapies in Lebanon.
The global cost-utility and budget impact models were adapted from Lebanese National Social Security Fund (NSSF) perspective. The data for the models' adaptation were retrieved from the literature and validated by Lebanese experts. The comparators considered in the cost-utility model were alemtuzumab, fingolimod, and natalizumab while budget impact analysis additionally considered dimethyl fumarate. A sensitivity analysis was also performed to assess the uncertainty in the analysis.
The cost-utility results showed that cladribine tablets are an economically dominant therapeutic strategy (i.e., less costly and better quality-adjusted life year [QALY]) compared to all comparators. The cost saving was driven by drug acquisition, administration, and monitoring costs; while incremental QALY gain was driven by differences in delayed Expanded Disability Status Scale progression. Sensitivity analysis showed that cladribine tablets have a high probability (99.3-100%) of being dominant at a threshold of 22,000 United States Dollars (approximately three times of gross domestic product) per QALY gained against different comparators. The budget impact analysis showed that the introduction of cladribine tablets would result in 5.0% to 21.5% savings in the overall budget over a period of five years.
Cladribine tablets are a cost-effective and a budget-saving treatment option for the treatment of HDA-RMS patients in Lebanon from the NSSF perspective.
克拉屈滨片是一种新推出的短期口服治疗药物，适用于高疾病活动度（HDA）的复发型多发性硬化症（RMS）。本分析评估了在黎巴嫩，与其他 HDA-RMS 治疗方法相比，将克拉屈滨片用于 HDA-RMS 患者的成本效益和预算影响。
全球成本效益和预算影响模型从黎巴嫩国家社会保障基金（NSSF）的角度进行了改编。模型改编的数据从文献中检索，并由黎巴嫩专家进行了验证。成本效益模型中考虑的比较药物为阿仑单抗、芬戈莫德和那他珠单抗，而预算影响分析还考虑了富马酸二甲酯。还进行了敏感性分析，以评估分析中的不确定性。
成本效益结果表明，与所有比较药物相比，克拉屈滨片是一种经济上具有优势的治疗策略（即成本更低，质量调整生命年[QALY]更高）。成本节约是由药物获得、管理和监测成本驱动的；而增量 QALY 增益是由扩展残疾状态量表进展延迟的差异驱动的。敏感性分析表明，克拉屈滨片在不同比较药物的 22000 美元（约为国内生产总值的三倍）每 QALY 获益阈值下，具有 99.3%至 100%的高概率（优势）。预算影响分析表明，在五年期间，引入克拉屈滨片将使总体预算节省 5.0%至 21.5%。
从 NSSF 的角度来看，克拉屈滨片是治疗黎巴嫩 HDA-RMS 患者的一种具有成本效益和节省预算的治疗选择。
