Direct cost of rituximab treatment in multiple sclerosis: A real-world finding from Malaysia

Abstract

Background & Objective: Multiple sclerosis (MS) imposes a significant economic burden on the healthcare system. In 2022, more than half of the Neurology budget of Hospital Seberang Jaya was spent on rituximab, an off-label drug for treating MS. Recently, the availability of rituximab biosimilar had provided an opportunity for cheaper treatment alternatives for subsidised patients or patients opting to self-purchase the medication. This study aimed to estimate the clinical outcome and cost of treatment of MS patients on Mabthera (originator) and Truxima (biosimilar). Methods: A retrospective analysis of MS patients treated with rituximab from April 2018 to April 2023 was performed. Clinical charts and documented adverse events were reviewed. Healthcare costs were estimated based on rituximab treatment, hospitalisation charges, personnel and other diagnostic costs. Results: Four patients treated with Mabthera and three with Truxima, with follow-up, ranging from 1 to 5 years (median: 3 years), were included. Two relapses occurred during follow-up, whereby one Mabthera and Truxima patient, respectively. Expanded Disability Status Scale (EDSS) score improved in four patients, three patients treated with Mabhtera and one patient treated with Truxima. MR imaging reported no new changes in all the patients and a new lesion in one Truxima-treated patient. The estimated treatment drug cost of Mabthera was USD 7294.62 per patient/year and Truxima USD 3612.90 per patient/year. The total estimated personnel cost for a typical 2-day admission without complication is USD 62.26, the diagnostic cost for a complete blood count and urinalysis is USD 2.37, and the bedding cost is USD 1.29 for a typical two days. The total cost difference in treatment is affected mainly by the rituximab drug cost unless patients with urinary tract infection on day 14 are treated, and the length of stay is prolonged with antibiotics administration. Conclusion: Our findings showed that Mabthera and Truxima were well tolerated. There is a significant difference in the cost of rituximab (p=0.026), bedding cost (p=0.048), healthcare professional cost(p=0.048) and the total cost (p=0.032) among patients on Mabthera and Truxima. However, as the number of patients treated with Truxima is limited, a longitudinal cohort or multi-centre approach could be carried out.