Cost-effectiveness of disease-modifying treatments for multiple sclerosis in Bulgaria based on evidence from real world settings

Abstract

Abstract Background: This study aims to provide insight on the early application of high efficacy 2nd line DMDs from Bulgarian public payer perspective, referring to RWD. Methods: An Excel-based model was developed to compare the effectiveness of 1st vs 2nd line DMDs in terms of ARRs and the direct medical costs over the 4-year follow up period. MS therapies were categorized in two groups (1st and 2nd line) according to public payer guidelines. The results of the cost-effectiveness analysis are presented as an ICER. Results: The ARR of 0,385 for 1st line DMDs was significantly higher than the one for 2nd line DMDs, which was 0,153. The direct medical costs were 18 548 BGN and 33 857 BGN for 1st and 2nd line DMDs respectively. Thus, the incremental cost-effectiveness ratio (ICER) was 63 950 BGN per relapse avoided, which is slightly above the informal threshold of 3 x GDP per capital. Conclusion: The results of this study showed that escalation to 2nd line DMDs is a cost-effective approach in RRMS patients who do not respond adequately to conventional 1st line DMDs. Although 2nd line DMDs direct medical costs were substantially higher, early escalation might produce long-term savings.