Smets Ide, Versteegh Matthijs, Huygens Simone, Corsten Cato, Wokke Beatrijs, Smolders Joost
Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
Huygens & Versteegh, Zwijndrecht, The Netherlands.
Mult Scler J Exp Transl Clin. 2023 Jul 24;9(3):20552173231189398. doi: 10.1177/20552173231189398. eCollection 2023 Jul-Sep.
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.
Comparing differences in benefits between anti-CD20 mAbs from a health-economic and societal perspective.
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.
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.
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.
在高收入国家，四种抗CD20单克隆抗体（mAb）被用于复发型多发性硬化症（MS）的治疗或正处于研发阶段：奥瑞珠单抗、奥法妥木单抗（均已获批上市）、ublituximab（正在等待获批）和利妥昔单抗（用于未获批适应症）。获批上市药物和未获批适应症药物的标价差异显著。
从卫生经济学和社会角度比较抗CD20单克隆抗体在获益方面的差异。
为反映疾病修正治疗（DMT）的终身使用情况，我们使用了一种治疗序列模型，比较奥瑞珠单抗/奥法妥木单抗与其他八类药物在健康指标（终身复发次数、达到扩展残疾状态量表[EDSS]评分为6的时间、终身质量调整生命年）和成本效益（净健康效益）方面的差异。为了与奥瑞珠单抗相比具有成本效益，我们模拟了ublituximab的标价以及利妥昔单抗对EDSS进展的预期效果。
尽管一线和二线使用奥瑞珠单抗的药物序列比奥法妥木单抗更具成本效益，但我们的概率分析表明这一结果非常不确定。要比奥瑞珠单抗更具成本效益，ublituximab需要便宜约25%，而利妥昔单抗需要达到一线治疗对残疾进展的影响效果。
我们的模型显示奥瑞珠单抗和奥法妥木单抗在成本效益方面没有明显差异。因此，开具成本最低的抗CD20单克隆抗体可以使MS治疗更加普及，同时不会损失健康效益。
