Cost-Effectiveness of Dimethyl Fumarate Versus Teriflunomide in Patients With Relapsing-Remitting Multiple Sclerosis (RRMS) in Iran.

Background and Aims: Multiple sclerosis (MS) is an autoimmune disorder that damages the myelin sheath on nerve fibers in the central nervous system, leading to axonal damage and neuron death. This study aimed to assess the cost-effectiveness of dimethyl fumarate compared with teriflunomide as first-line oral medications for patients with Relapsing-Remitting Multiple Sclerosis (RRMS) in southern Iran in 2022. Methods: This cost-effectiveness study utilized a Markov model with a lifetime horizon and included 246 randomly selected patients from the MS Center of Shiraz University of Medical Sciences. The study adopted a societal perspective, accounting for all direct medical, direct non-medical and indirect costs. Direct medical cost includes visits, buying medications, the MRI cost, testing, hospitalization, and physiotherapy. Direct non-medical included costs related to patient travel, accommodation in other cities, food costs, and home nursing care, identified through patient interviews and indirect costs include lost income. Outcomes were measured in terms of Quality Adjusted Life Years (QALY) and average relapse rates. One-way and probabilistic sensitivity analyses were conducted using TreeAge and Excel 2016 software for modeling and data analysis. Results: The study found that dimethyl fumarate was more cost-effective than teriflunomide, with lower costs ($35,253 vs. $44,340) and higher QALYs (5.30 vs. 5.24) in Iran. Dimethyl fumarate also had lower relapse rates. Sensitivity analyses, including a tornado diagram, supported these findings. Dimethyl fumarate was identified as the best treatment strategy in 66% of simulations, making it the preferred option across different payment scenarios. Overall, using dimethyl fumarate was shown to be a cost-effective treatment compared to teriflunomide. Conclusion: The results showed that dimethyl fumarate has a lower cost and is more effective than teriflunomide. Given its favorable cost-effectiveness profile-characterized by both lower costs and greater effectiveness compared with teriflunomide-dimethyl fumarate represents a more economically and clinically advantageous option, supporting its consideration as a first-line oral therapy for relapsing-remitting multiple sclerosis in settings where resource allocation is a key concern.