Cost-Utility of Fingolimod Compared With Dimethyl Fumarate (Dmf) In Highly Active Relapsing Remitting Multiple Sclerosis (Rrms) In England: Comparison of A Markov and Discrete Event Simulation Model.

Table 1. Markov5 and DES model calculations of the level of dimethyl fumarate patient access scheme discount required to change the base case conclusion that fingolimod is cost-effective at willingness-to-pay thresholds of £20,000 and £30,000 per QALY INTRODUCTION • Multiple Sclerosis (MS) is a chronic immune-mediated disease characterised by inflammation of the central nervous system, causing symptoms such as movement problems and sensory disturbances that usually follow a relapsing-remitting pattern (RRMS), before progressing to the secondary-progressive phase (SPMS).1, 2 • Fingolimod is an immunomodulatory, disease-modifying therapy (DMT) that is licensed in the EU for patients with RRMS that is highly active (HA) despite treatment with at least one other DMT; it is also licensed in the EU for rapidly evolving severe (RES) RRMS.3, 4 NICE has recommended fingolimod for HA RRMS, but currently recommends dimethyl fumarate for RRMS that is not HA or RES.