Analysis Finds Alemtuzumab Most Cost-Effective Treatment for Multiple Sclerosis

A review of 15 disease-modifying therapies (DMTs) for the treatment of relapsing-remitting and primary-progressive multiple sclerosis (MS) has found that prices for most of these drugs are not well-aligned with added value for patients.

The Institute for Clinical and Economic Review (ICER) analyzed the improved health outcomes related to delayed disability and prevention of relapses for each DMT and how well they worked compared with generic glatiramer acetate.

“Evidence suggests that all of these drugs can play a significant role in delaying disability and preventing relapse in MS, two factors that we know are of the highest importance to patients,” ICER President Steven D. Pearson, MD, MSc, said in a statement. “But, survey results included in the report show that patients are often limited in their treatment choices due to financial and coverage barriers.”

He added that the goal of ICER’s review was to spur discussion and to ensure patients have access to the right medication for them at the right price.

The report included clinical and economic analyses, as well as findings from discussions with patient groups and the results of a survey highlighting patient values in treatment decisions. The surveys and discussions found patients’ top priorities were delaying disability and preventing relapses.

All of the drugs reviewed showed a high certainty of at least a small net health benefit regarding delay of disability and prevention of relapse. However, there was a high relative cost with cost-effectiveness thresholds exceeding the $100,000 to $150,000 per quality-adjusted life year (QALY) threshold for most of the MS drugs.

The report determined that alemtuzumab was most cost effective at $34,659 per QALY compared with supportive care. Alemtuzumab, along with natalizumab and ocrelizumab, had the greatest reduction in annual relapse rate (approximately 70%), and alemtuzumab and ocrelizumab both had the greatest reduction in disability progression (58% to 53%, respectively).

However, ICER noted that even though alemtuzumab is the most cost effective, it “may only be suitable for a subset of patients due to its safety profile.” The boxed warning for the treatment includes serious (sometimes fatal) autoimmune conditions and that the drug may increased risk of malignancies. In clinical trials, 92% of patients experienced an infusion reaction, 53% experienced rash, and 99.9% experienced lymphopenia, the condition of having an abnormally low level of lymphocytes in the blood.

The agents reviewed were:

Injectable Agents

• Daclizumab (Zinbryta by Biogen and AbbVie)
• Glatiramer acetate (Copaxone by Teva)
• Glatiramer acetate (Glatopa by Sandoz)
• Interferon beta-1a (Avonex by Biogen)
• Interferon beta-1a (Rebif by EMD Serono)
• Interferon beta-1b (Betaseron by Bayer)
• Interferon beta-1b (Extavia by Novartis)
• Peginterferon beta-1a (Plegridy by Biogen)

Oral Agents

• Dimethyl fumarate (Tecfidera by Biogen)
• Fingolimod (Gilenya by Novartis)
• Teriflunomide (Aubagio by Sanofi-Genzyme)

Infused Agents

• Alemtuzumab (Lemtrada by Sanofi-Genzyme)
• Natalizumab (Tysabri by Biogen)
• Ocrelizumab (Ocrevus by Roche/Genentech)
• Rituxumab (Rituxan by Roche/Genentech) (Note: not approved by the FDA for MS)