Pharmacoeconomic analysis of the use of first- and second-line drugs in the treatment of multiple sclerosis

Objective: to make a pharmacoeconomic comparison of the administration of first- and second-line drugs in the treatment of multiple sclerosis through cost, cost-effectiveness, and budget impact analyses using the 2015 state prices.

Material and methods. A pharmacoeconomic analysis was carried out on the basis of the data available in the literature on trials of the effects of the drugs on the rates of exacerbations and disability. On calculating, the authors took into account the current standards for the out- and inpatient management of patients with this nosological entity in accordance with the compulsory health insurance (CHI) program; prices for state drug purchases in March 2015; prices for medical services in compliance with the CHI standards in Moscow in 2015; the average sizes of minimum wage, salary, and disability grants with consideration for a discount rate of 3%. The cost-effectiveness and budget impact analyses were performed for intramuscular interferon (INF)-β1a (avonex, 30 μg), subcutaneous INF-β1a (rebif, 44 μg), subcutaneous INF-β1b (ronbetal, 8,000,000 IU), subcutaneous INF-β1b (betaferon, 9,600,000 IU), subcutaneous glatiramer acetate (copaxone, 20 mg), intravenous natalizumab (tyzabri, 300 mg), and oral fingolimod (gilenya, 0.5 mg).

Results and discussion. The second-line drug tyzabri outperforms the first-line agents for cost-effectiveness. The first-line drugs betaferon and copaxone is slightly exceeded in this indicator by tyzabri; the other both first- and second-line agents compared are all the more inferior in this indicator. The budget impact analysis has shown that the cost of the second-line drugs was higher than that of the first-line ones.

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