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Efficiency Model of Cladribine Tablets Versus Infusion-Based Disease-Modifying Drugs for Patients with Relapsing-Remitting Multiple Sclerosis

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Abstract

Introduction

To develop a simulation model assessing the efficiency of using cladribine tablets versus infusion-based disease-modifying drugs (DMDs) for the treatment of relapsing-remitting multiple sclerosis (RRMS) from a facility perspective in the UK.

Methods

A scheduling algorithm was developed to simulate day-case admissions and calculate the mean changes to resource use and time burden for patients in a facility that transitions from infusion-based treatments to cladribine tablets over 1 year. Model inputs and assumptions were based on previous research and expert opinion. Model validation and quality checks were performed and additional scenario analyses were also conducted.

Results

The model successfully scheduled all infusion treatments in the base case and no patients were left off the schedule as a result of lack of capacity. Modeled base-case outcomes increased in future scenarios owing to a 35% increase in demand. The introduction of cladribine tablets reduced these impacts. Specifically, the difference in mean daily utilization was reduced in the future scenario from 13% to 3% as 8% of patients moved to cladribine tablets; annual administration costs decreased by 96% and annual time burden decreased by 90%. Results from additional scenarios showed the largest benefits from switching current infusion patients to cladribine tablets were realized in facilities having moderate to high resource utilization.

Conclusions

This model provides facility decision-makers the ability to assess the efficiency of using cladribine tablets rather than an infusion-based DMD. The simulation quantified the benefits gained from reducing the burden on facility resources by switching some patients with RRMS from infusion-based DMDs to cladribine tablets. Overall, modeled outcomes increased in future scenarios owing to an increase in demand, although the introduction of cladribine tablets reduced this impact.

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Acknowledgements

Funding

Financial support for this study and the Rapid Service Fee was provided by a contract between EMD Serono, Inc. a business of Merck KGaA, Darmstadt, Germany and Evidera.

Medical Writing and/or Editorial Assistance

The authors wish to thank Jason Allaire, PhD of Generativity Solutions Group for his assistance with editing the paper. This assistance was funded by EMD Serono, Inc.

Authorship

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.

Author Contributions

AT: conducted research, analysis, manuscript development; AC: conducted research, analysis manuscript development; GH: conducted interpretation and manuscript development; JM: conducted interpretation and manuscript development; SLW: conducted interpretation and manuscript development.

Disclosures

Gerard Harty and Schiffon L. Wong are employees of EMD Serono, Inc. and hold stock in EMD Serono, Inc. Ali Tafazzoli, Ameya Chavan, and Jorgen Moller are employed by Evidera, a consultancy, who received funds from EMD Serono for developing this efficiency model.

Compliance with Ethics Guidelines

This article is not based on a study/studies that involved human participants or animals, performed by any of the authors.

Data Availability

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

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Authors and Affiliations

  1. Evidence Synthesis, Modeling and Communication, Evidera, Bethesda, MD, USA

    Ali Tafazzoli & Ameya Chavan

  2. Global Evidence and Value Development, Global Research and Development, EMD Serono, Inc, Billerica, MA, USA

    Gerard Harty & Schiffon L. Wong

  3. Evidence Synthesis, Modeling and Communication, Evidera, London, UK

    Jorgen Moller

Authors
  1. Ali Tafazzoli
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  2. Ameya Chavan
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  3. Gerard Harty
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  4. Jorgen Moller
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  5. Schiffon L. Wong
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Corresponding author

Correspondence to Gerard Harty.

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Tafazzoli, A., Chavan, A., Harty, G. et al. Efficiency Model of Cladribine Tablets Versus Infusion-Based Disease-Modifying Drugs for Patients with Relapsing-Remitting Multiple Sclerosis. Adv Ther 37, 3791–3806 (2020). https://doi.org/10.1007/s12325-020-01426-7

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  • DOI: https://doi.org/10.1007/s12325-020-01426-7

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