Inshasi Jihad, Nowier Yomna, Zimovetz Evelina A, Moussa Ahmed, Shatila Ahmed, Hassan Ali, Farghaly Mohamed, Thakre Mona, Shakra Mustafa, Dallal Sara Al, Noori Suzan I A, Alabdin Tayseer Zain, Khattab Sherouq, Yamout Bassem
Neurology Department, Rashid Hospital, Dubai, United Arab Emirates.
Dubai Medical College, Dubai Academic Health Corporation, United Arab Emirates.
Ther Adv Neurol Disord. 2025 Apr 28;18:17562864251330260. doi: 10.1177/17562864251330260. eCollection 2025.
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system, associated with demyelination and inflammation. Relapsing forms of MS (RMS) encompass all patients with MS experiencing relapses. While there is currently no cure for MS, the introduction of several disease-modifying therapies (DMTs) has significantly reduced the risk of relapse and disability in patients with MS. There is a high unmet need for an easy-to-administer DMT that can be used early in the treatment pathway.
This study aimed to evaluate the cost-effectiveness of ofatumumab compared with other commonly used DMTs for the treatment of RMS from a health payer perspective in the United Arab Emirates (UAE).
A cost-effectiveness analysis.
A Markov model, based on expanded disability status scale (EDSS) health states, was developed using the UAE payer's perspective and a 65-year time horizon. The baseline patient distribution across the EDSS states was aligned to the population of ASCLEPIOS I and II trials. The British Columbia database informed natural history transition probabilities. Treatment effects were applied by delaying disability progression and reducing the number of relapses and were sourced from a network meta-analysis. The health care resource utilization was derived from interviews with local experts, who also validated the model structure and comparators, and utility inputs from published studies. In the absence of an officially defined willingness-to-pay threshold in the UAE, it was assumed to be United Arab Emirates Dirham (AED) 369,854 per quality-adjusted life-year (QALY), which is twice the UAE gross domestic product per capita.
Base-case results indicated that ofatumumab was dominant over ocrelizumab, dimethyl fumarate, fingolimod, and natalizumab intravenous; was more cost-effective compared with teriflunomide, fingolimod (generic), glatiramer acetate, interferons, and best supportive care; and resulted in an incremental cost-effectiveness ratio of AED 713,068 per QALY versus cladribine. Sensitivity analyses were in line with the results of the base-case analysis.
From the UAE payer's perspective, ofatumumab could be a cost-effective treatment alternative for patients with RMS.
多发性硬化症（MS）是一种中枢神经系统的自身免疫性疾病，与脱髓鞘和炎症相关。复发型多发性硬化症（RMS）包括所有经历复发的MS患者。虽然目前MS无法治愈，但几种疾病修正疗法（DMTs）的引入显著降低了MS患者复发和残疾的风险。对于一种易于给药且可在治疗早期使用的DMT存在高度未满足的需求。
本研究旨在从阿联酋（UAE）医疗支付方的角度评估奥法妥木单抗与其他常用DMTs治疗RMS的成本效益。
成本效益分析。
基于扩展残疾状态量表（EDSS）健康状态开发了一个马尔可夫模型，采用阿联酋支付方的视角和65年的时间范围。EDSS状态下的基线患者分布与ASCLEPIOS I和II试验的人群一致。不列颠哥伦比亚数据库提供自然史转变概率。通过延迟残疾进展和减少复发来应用治疗效果，这些数据来自网络荟萃分析。医疗资源利用情况来自对当地专家的访谈，专家们还验证了模型结构和对照物，以及已发表研究中的效用输入。在阿联酋没有官方定义的支付意愿阈值的情况下，假定为每质量调整生命年（QALY）369,854阿联酋迪拉姆（AED），这是阿联酋人均国内生产总值的两倍。
基础病例结果表明，奥法妥木单抗优于奥瑞珠单抗、富马酸二甲酯、芬戈莫德和静脉注射那他珠单抗；与特立氟胺、芬戈莫德（非专利药）、醋酸格拉替雷、干扰素和最佳支持治疗相比，成本效益更高；与克拉屈滨相比，每QALY的增量成本效益比为713,068 AED。敏感性分析与基础病例分析结果一致。
从阿联酋支付方的角度来看，奥法妥木单抗可能是RMS患者具有成本效益的治疗选择。
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