Cost-utility analysis of teriflunomide in naïve vs. previously treated patients with relapsing-remitting multiple sclerosis in Italy

Matters arising: cost-utility and cost-effectiveness analysis of disease-modifying drugs of relapsing-remitting multiple sclerosis: a systematic review

BACKGROUND

In their interesting systematic review, Gallehzan et al. quoted our article Cost-utility analysis of teriflunomide in naïve vs. previously treated patients with relapsing-remitting multiple sclerosis (RRMS) in Italy. While we are grateful to Gallehzan et al. for their interest in the aim of our research, we would like to clarify some points.

METHODS

We compare Gallehzan et al.'s statements about our article with the original publication.

RESULTS

Gallehzan et al. omitted or misreported some relevant methodological issues and findings presented in our article. As far as methods are concerned, the main omissions were the 7-year time horizon of our study (that falls in between the 5-10 years range mentioned by Gallehzan et al. for other contributions) and the number of simulated RRMS naïve patients (1000). Regarding findings, Gallehzan et al. mistook the 0.480 incremental Quality-Adjusted Life Year gained by RRMS naïve patients vs. RRMS experienced patients on teriflunomide for the base case Incremental Cost-Utility Ratio (ICUR) calculated according to the societal viewpoint. In fact, for both the healthcare sector and societal perspectives adopted in our Markov model-based cost-utility analysis, the baseline results showed teriflunomide in RRMS naïve patients to be strongly dominant (that is, producing more QALYs and being, at the same time, cost-saving) vs. RRMS experienced patients. Therefore, the calculation of the two ICURs was not necessary.

CONCLUSIONS

As systematic reviews play a remarkable role in disseminating health economic research, a careful description of the methods and the findings reported in the included studies is of paramount importance.

Cost-utility and cost-effectiveness analysis of disease-modifying drugs of relapsing-remitting multiple sclerosis: a systematic review

BACKGROUND

Multiple sclerosis (MS) is a chronic, autoimmune, and inflammatory disease. The economic burden of MS is substantial, and the high cost of Disease-modifying drugs (DMDs) prices are the main drivers of healthcare expenditures. We conducted a systematic review of studies evaluating the cost-utility and cost-effectiveness of DMDs for relapsing-remitting multiple sclerosis (RRMS).

MATERIALS AND METHOD

Searches were conducted in PubMed, Web of Science, Scopus, and Embase. The search covered articles published between May 2001 and May 2023. Studies that were written in English and Persian and examined the cost-utility and cost-effectiveness of DMDs in patients with MS were included in our review. Data extraction was guided by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, and the quality of economic evaluations was assessed using the Quality of Health Economics Studies Instrument (QHES). All costs were converted to 2020 U.S. dollars using Purchasing Power Parity (PPP).

RESULTS

The search yielded 1589 studies, and 49 studies were eligible for inclusion. The studies were mainly based on a European setting. Most studies employed Markov model to assess the cost-effectiveness. The lowest and highest numerical value of outcome measures were -1,623,918 and 2,297,141.53, respectively. Furthermore, the lowest and highest numerical value of the cost of DMDs of RRMS were $180.67, and $1474840.19, respectively.

CONCLUSIONS

Based on the results of all studies, it can be concluded that for the treatment of patients with MS, care-oriented strategies should be preferred to drug strategies. Also, among the drug strategies with different prescribing methods, oral disease-modifying drugs of RRMS should be preferred to injectable drugs and intravenous infusions.

Teriflunomide treatment outcomes in multiple sclerosis: A Portuguese real-life experience

Teriflunomide is an oral disease-modifying therapy for relapsing-remitting multiple sclerosis patients. A decline in physical and cognitive functions, which negatively impacts their quality of life (QoL), is observed in relapsing-remitting multiple sclerosis patients. The aim of this study was to characterise adult Portuguese relapsing-remitting multiple sclerosis patients treated with teriflunomide in routine clinical practice concerning their quality of life, comorbidities, treatment effectiveness, satisfaction, compliance and safety. TeriLIVE-QoL was a multicentre, non-interventional, prospective cohort study that collected demographic and clinical characteristics, patient-reported outcomes and adverse events from patients treated with teriflunomide of 14 mg over 2 years. Notably, around 18 months of this period occurred during the COVID-19 pandemic. Of the 99 participants, 25% were treatment-naïve. Annualised relapse rate and the score for the Hospital Anxiety and Depression Scale decreased after 1 (p = 0.01) and 2 years of treatment (p < 0.001), respectively. Convenience (p = 0.001), effectiveness (p = 0.002) and global satisfaction scores (p < 0.001) presented high values (up to 95.6) and continued to improve along the study. Treatment persistence was 77%, and compliance reached 82% 2 years after initiation. Three patients experienced serious adverse events. TeriLIVE-QoL provides real-world evidence of clinical effectiveness, high treatment satisfaction, consistent safety and improved psychiatric outcomes, associated with elevated treatment persistence and compliance in patients treated with teriflunomide.iance reached 82% 2 years after initiation. Three patients experienced serious adverse events.