Cost-effectiveness of delayed-release @entity15626 for the treatment of relapsing forms of XXXX in the United States.

@entity1 @entity1638 @entity9104 @entity20083 @entity15626 @entity15
OBJECTIVE: To assess the cost-effectiveness of delayed-release @entity15626 ( @entity9104 , also known as gastro-resistant @entity9104 ), an effective therapy for relapsing forms of @entity15 ( @entity15 ), compared with @entity1638 and @entity20083 , commonly used treatments in the US. METHODS: A Markov model was developed comparing delayed-release @entity9104 to @entity1638 and @entity20083 using a US payer perspective and 20-year time horizon. A cohort of @entity1 , mean age 38 years, with relapsing-remitting @entity15 and Kurtzke Expanded Disability Status Scale (EDSS) scores between 0-6 entered the model. Efficacy and safety were estimated by mixed-treatment comparison of data from the DEFINE and CONFIRM trials and clinical trials of other disease-modifying therapies. Data from published studies were used to derive resource use, cost, and utility inputs. Key outcomes included costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Alternative scenarios tested in a sensitivity analysis included drug efficacy, EDSS-related or relapse-related costs, alternative perspectives, drug acquisition costs, and utility. RESULTS: Base-case results with a 20-year time horizon indicated that delayed-release @entity9104 increased QALYs +0.450 or +0.359 compared with @entity1638 or @entity20083 , respectively. Reductions in 20-year costs with delayed-release @entity9104 were - 70,644 compared with once-daily @entity1638 and - 32,958 compared with @entity20083 . In an analysis comparing delayed-release @entity9104 to three-times-weekly @entity1638 and assuming similar efficacy and safety to the once-daily formulation, 20-year costs with delayed-release @entity9104 were increased by  15,806 and cost per QALY gained was  35,142. The differences in costs were most sensitive to acquisition cost and inclusion of informal care costs and productivity losses. The differences in QALYs were most sensitive to the impact of delayed-release @entity9104 on disease progression and the EDSS utility weights. CONCLUSION: Delayed-release @entity9104 is likely to increase QALYs for @entity1 with relapsing forms of @entity15 and be cost-effective compared with @entity20083 and @entity1638 .
