Cost effectiveness of different treatment strategies with natalizumab for pregnant women with Multiple Sclerosis

Walbaum, Magdalena ORCID: 0000-0002-2179-9224, Madhukar, Anushka, Dobson, Ruth, Cyhlarova, Eva ORCID: 0000-0002-1755-6676, Castro‑Aldrete, Laura, Santuccione Chadha, Antonella and Knapp, Martin ORCID: 0000-0003-1427-0215 (2025) Cost effectiveness of different treatment strategies with natalizumab for pregnant women with Multiple Sclerosis. Journal of Neurology, 272 (1). ISSN 0340-5354

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Abstract

BACKGROUND: The management of multiple sclerosis (MS) during pregnancy poses significant challenges. This study aimed to evaluate the cost-effectiveness of three natalizumab treatment strategies during pregnancy from the UK healthcare system's perspective. METHODS: A Markov model was developed to assess the health outcomes and costs associated with three treatment strategies: continuous natalizumab treatment throughout pregnancy, treatment until the first trimester followed by discontinuation, and discontinuation at conception with resumption post-pregnancy. The model incorporated data on relapse rates, disability progression, costs and quality-adjusted life years (QALYs). Sensitivity analyses were conducted. RESULTS: Continuing natalizumab throughout pregnancy was the most cost-effective strategy, yielding the highest incremental QALY gains and the lowest incremental cost per QALY (£1713 per QALY), with a net monetary benefit of £743. The sensitivity analyses confirmed the robustness of these findings and the use of generic or biosimilar forms of natalizumab further reinforced the cost-effectiveness of continuous treatment, with the biosimilar option proving cost-saving. CONCLUSION: Continuing natalizumab treatment throughout pregnancy is the most cost-effective approach for managing MS in pregnant women. These findings should inform clinical guidelines and support healthcare providers and women with MS planning their family in making evidence-based decisions to improve the management of MS during pregnancy.

Item Type:	Article
Additional Information:	© 2024 The Authors
Divisions:	Care Policy and Evaluation Centre Health Policy
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RG Gynecology and obstetrics
Date Deposited:	12 Sep 2024 10:06
Last Modified:	14 Jan 2025 11:12
URI:	http://eprints.lse.ac.uk/id/eprint/125400

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