Cost-effectiveness of ocrelizumab for treatment of Iranian patients with relapsing multiple sclerosis

Background: The current study desired to conduct an economic analysis on ocrelizumab (OCR), a new relapsing multiple sclerosis (RMS) treatment strategy, in comparison to natalizumab (NTL), as one of the mostlyused diseasemodifying therapies (DMTs) in Iran. Methods: A 31healthstate Markov model, based on Expanded Disability Status Scale (EDSS), containing patients on and offtreatment with annual cycles was developed. Baseline demographics and utility scores were extracted from OPERA 1 and 2 trials. Confirmed disability progression (CDP) and annualized relapse rates (ARR) were extracted from the literature. Mortality was calculated based on age, sex, and disease state. Qualityadjusted life years (QALYs) and life years gained (LYG) were measurements of efficacy. Direct and indirect costs were identified and calculated based on the national book of tariffs in Iranian Rial (IRR) rates, then converted to the 2020 United States Dollar (USD). Final results were reported in terms of incremental costeffectiveness ratio (ICER), which showed extra costs required for one additional QALY. Robustness of the model was analyzed through deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA). Results: OCR dominated NTL and was associated with costsavings of 6971 USD, longer LYG (0.004), and higher QALYs (0.27). Although OCR had higher acquisition costs, which was the main component in both comparator arms, it was associated with lower total costs, due to lower disability progression and productivity loss. Results remained robust in DSA and PSA (93.5% costeffectiveness in Iran’s pharmacoeconomic threshold, 2709 USD). Conclusion: Results suggested that OCR was a more costeffective option than NTL for the treatment of patients with RMS in Iran.