Cost-utility analysis comparing ocrelizumab vs rituximab in the treatment of relapsing-remitting multiple sclerosis: The Colombian perspective

Introduction Since 2017, the ocrelizumab is available to treat patients with relapsing-remitting multiple sclerosis (RRMS), together with rituximab, they have a similar effectiveness but different costs. In this context, the added value provided by cost-effectiveness estimators for decision-making and drug prescription can be considered. Objective to determine the cost-utility of ocrelizumab versus rituximab in patients with RRMS, from the perspective of the Colombian health system. Methodology cost-utility study based on a Markov model, with a 50-year horizon and payer perspective. The currency was the US Dollar (USD) for the year 2019, with a threshold of $5,180 USD defined for Colombian health system. The model used annual cycles according to the health status determined by the disability scale. Direct costs were considered, and the incremental cost-effectiveness ratio (ICER) per 1 quality-adjusted life year (QALY) gained was used as the outcome measure. A discount rate of 5% was applied for costs and outcomes. Multiple one-way deterministic sensitivity analyzes and 10,000 modeling through Monte Carlo simulation were performed. Results for the treatment of patients with RRMS, ocrelizumab versus rituximab had an ICER of $73,652 USD for each QALY gained. After 50 years, 1 subject treated with ocrelizumab earns 4.8 QALYs more than 1 subject treated with rituximab, but at a higher cost of $521,759 USD vs $168,752 USD, respectively. Ocrelizumab becomes a cost-effective therapy when its price is discounted >86%, or there is a high willingness to pay. Conclusions Ocrelizumab was not a cost-effective drug compared with rituximab to treat patients with RRMS in Colombia.