Cost of natalizumab (Tysabri) vs. fingolimod (Gilenya)

EpubHeisen et al Fingolimod Reduces Direct Medical Costs Compared to Natalizumab in Patients with Relapsing-Remitting Multiple Sclerosis in the Netherlands. J Med Econ. 2012 Jun 28.

Objective: To assess the costs of oral treatment with fingolimod compared to intravenous infusion of natalizumab in MSers with relapsing-remitting multiple sclerosis (RRMS) in the Netherlands. 

Methods: A cost-minimization analysis was used to compare both treatments. The following cost categories were distinguished: drug acquisition costs, administration costs, and monitoring costs. Costs were discounted at 4%, and incremental model results were presented over a 1, 2, 5, and 10 year time horizon. The robustness of the results was determined by means of a number of deterministic univariate sensitivity analyses. Additionally, a break-even analysis was carried out to determine at which natalizumab infusion costs a cost neutral outcome would be obtained.

Results: Comparing fingolimod to natalizumab, the model predicted discounted incremental costs of -€2,966 (95%CI: -€4,209;-€1,801), -€6,240 (95%CI: -€8,800;-€3,879), -€15,328 (95%CI: -€21,539;-€9,692) and -€28,287 (95%CI: -€39,661;-€17,955) over a 1, 2, 5, and 10-year time horizon, respectively. These predictions were most sensitive to changes in the costs of natalizumab infusion. Changing these costs of €255 within a range from €165 to €364 per infusion, resulted in cost savings varying from €4,031 to €8,923 after 2 years. The additional break-even analysis showed that infusion costs – including aseptic preparation of the natalizumab solution – needed to be as low as the respective costs of €94 and €80 to obtain a cost neutral result after 2 and 10 years. Limitations Neither treatment discontinuation and subsequent re-initiation nor patient compliance were taken into account. As a consequence of the applied cost-minimization technique, only direct medical costs were included.

Conclusion: The present analysis showed that treatment with fingolimod resulted in considerable cost savings compared to natalizumab: starting at €2,966 in the first year, increasing to a total of €28,287 after 10 years per RRMS patient in the Netherlands.

“The future of managed care will result in an increasing number of these kind of studies. Which drug is gives the biggest bang for buck spent? This is the aim of NICE in the UK; to ensure that the NHS gets the best value for money. What about MSer choice?”

2 thoughts on “Cost of natalizumab (Tysabri) vs. fingolimod (Gilenya)”

  1. Alright – let me raise my hand here and say that I am a professional economist.This is one post I can properly understand…. and it is the most absurd I have ever read since my diagnosis 3ys ago.It makes CCSVI look like a panacea.1) The premises of an overly complicated univariate analysis in a cost comparison makes me cry. You don't need regressions to compare costs. Basic algebra is enough. The rest are layers of non-sense (any econometrician will tell you so).2) The hypothesis of suggesting that Gilnea and Tysabri are comparable is absurd.Like-for-like averages show a c. 20 point differential in ARR (70% v.s.50%). What's the point in comparing the cost of an apple to the price of an orange.3) a cost analysis has to include all costs to be relevant (holisticism bias). This study is missing the relative socio-professional cost (job loss, extra care…) for each of the 2 drugs. If you relapse more, you're working less, need more medical attention and pay less taxes (and some neuros say that the relapse rate is correlated to disease progression).How did Heisen et al miss out on this aspect? I bet that the EUR28k figure over 10ys will seem irrelevant (I was told that the cost of MS in the UK is GBP 2.2M / person!) To conclude, this paper suffers from an overcomplicated methodology loaded with statistical jargon. The analysis falls short (at best) and may have a political aim behind it (can't see the COIs of the authors as only abstract is visible to non-subscribers).Rubbish. Shame.I beg you, no more money wasted on this crap. Please fund real scientists (EBV, ect…).

  2. "I beg you, no more money wasted on this crap".Is suspect that the producers of the one drug that beats the other are happy with this as it is marketeering. Unless someone takes the time to destroy the weird logic of the pieces, it is the take home message that is remembered

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