Defining routine fatigue care in Multiple Sclerosis in the United Kingdom: What treatments are offered and who gets them?

[摘要] Background: Evidence suggests that early highly efficacious therapy in relapsing multiple sclerosis issuperior to escalation strategies.Objective: A cost-consequence analysis simulated different treatment scenarios with ofatumumab (OMB),dimethyl fumarate (DMF) and glatiramer acetate (GA): immediate OMB initiation as first treatment, earlyswitch to OMB after 1 year on DMF/GA, late switch after 5 years or no switch.Methods: An EDSS-based Markov model with a 10-year time horizon was applied. Cycle transitionsincluded EDSS progression, improvement or stabilization, treatment discontinuation, relapse or death.Input data were extracted from OMB trials, a network meta-analysis, published literature, and publiclyavailable sources.Results: The late switch compared to the immediate OMB scenario resulted in a lower proportion ofpatients with EDSS 0–3 (Δ −7.5% DMF; Δ −10.3% GA), more relapses (Δ +0.72 DMF; Δ +1.23GA) and lower employment rates (Δ −4.0% DMF; Δ −5.6% GA). The same applies to late versusearly switches. No switch scenarios resulted in worse outcomes. Higher drug acquisition costs in the immediate OMB and early switch scenarios were almost compensated by lower costs for patient care and productivity loss.Conclusion: Immediate OMB treatment and an early switch improves clinical and productivity outcomeswhile remaining almost cost neutral compared to late or no switches.

[关键词] multiple sclerosis;disease-modifying therapies;disability progression;societal costs