Cost per response analysis of repository corticotropin injection versus other alternative treatments for acute exacerbations of multiple sclerosis

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Abstract

Background: Relapses are common in patients with multiple sclerosis (MS) even after the use of disease-modifying therapies. Repository corticotropin injection (RCI), plasmapheresis (PMP), and intravenous immunoglobulin (IVIg) may be utilized as alternative therapies in the management of MS relapse. There is a lack of health economic studies on these alternative therapies for the acute exacerbations of MS. The objective of this study was to estimate the cost per response of RCI compared with PMP or IVIg from the United States (US) commercial payer perspective.

Methods: Costs and response rates were sourced from published peer-reviewed observational studies. The cost of care included MS-related inpatient, outpatient, and medication costs. Treatment response was defined as no evidence of additional relapse treatment or procedure claims within 30 days after treatment. The cost per response for each treatment was calculated by dividing the total annual cost of care by the proportion of patients with resolved relapse for each treatment. The incremental cost per response ratio was calculated by dividing the difference in costs and the proportion of responses for RCI versus PMP or IVIg. One-way sensitivity analysis (OWSA) was conducted for both costs and response rates. All included costs were inflated to the 2019 US dollars.

Results: With a lower total annual cost of care and a higher response rate, RCI had a lower cost per response (US$141,970) compared with PMP or IVIg (US$253,331). RCI had a lower cost per response even when more stringent estimates for RCI were applied in the OWSA. The annual cost of care had a greater influence on the cost per response in the OWSA.

Conclusions: Based on the estimates from the real-world evidence, our economic evaluation suggests that RCI may have real-world clinical and economic benefits for patients with MS relapse who fail on corticosteroid therapy.

Keywords: cost per response, multiple sclerosis, relapse, repository corticotropin injection.

Citation: Wan GJ, Chopra I, Niewoehner J, Hunter SF. Cost per response analysis of repository corticotropin injection versus other alternative treatments for acute exacerbations of multiple sclerosis. Drugs in Context 2020; 9: 2020-9-4. DOI: 10.7573/dic.2020-9-4

Prior presentation: This study was presented, in part or full, at the 2019 Annual ECTRIMS Congress in Stockholm, Sweden on September 12, 2019.

Contributions: All authors contributed equally to the preparation of this review. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: All authors declare that they have no conflicts of interest. GJW and JN are employees of Mallinckrodt Pharmaceuticals and IC was paid consultant fees from at Mallinckrodt Pharmaceuticals for the duration of the project. SFH is a research collaborator and has received speaker honoraria, consulting agreements, and grant/research financial support from AbbVie, Acorda, Actelion, Adamas, Alkermes, Avanir, Bayer, Biogen Idec, Novartis, Osmotica, Mallinckrodt, Roche, Sanofi, Synthon, and Teva. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/11/dic.2020-9-4-COI.pdf

Acknowledgements: Falcon Research Group (North Potomac, MD, USA) provided medical writing and editorial assistance; these services were funded by Mallinckrodt Pharmaceuticals (Bedminster, NJ, USA).

Funding declaration: This study was sponsored by Mallinckrodt Pharmaceuticals. The article processing charges and the open access fee for this publication were funded by Mallinckrodt Pharmaceuticals.

Copyright: Copyright © 2020 Wan GJ, Chopra I, Niewoehner J, Hunter SF. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Wan GJ, Chopra I, Niewoehner J, Hunter SF. https://doi.org/10.7573/dic.2020-9-4. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/cost-per-response-analysis-of-repository-corticotropin-injection-versus-other-alternative-treatments-for-acute-exacerbations-of-multiple-sclerosis

Correspondence: George J Wan, Mallinckrodt Pharmaceuticals, 1425 US Route 206, Bedminster, NJ, USA. george.wan@mnk.com

Provenance: Submitted; externally peer reviewed.

Submitted: 23 September 2020; Accepted: 21 November 2020; Publication date: 16 December 2020.

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