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Testing for anti-drug antibodies to guide treatment switching could improve clinical- and cost- effectiveness of MS treatment. We assess the value of testing for anti-drug antibodies to alemtuzumab, an effective but immunogenic MS therapy. We developed a microsimulation model to project disease progression, quality of life, and cost outcomes in people with relapsing-remitting MS initiating alemtuzumab treatment without and with alemtuzumab anti-body testing. Risk of anti-drug antibody development was informed by a UK cohort study of alemtuzumab-treated people with MS. UK guidance informed MS treatment strategies. Alemtuzumab anti-drug antibody test-directed treatment switching resulted in 0.02 fewer MS relapses per person; prolonged time to secondary progressive disease by 0.06 years; and yielded 0.02 additional years of life (0.06 Quality-Adjusted Life Years (QALY)). At \u00a325\/test, incremental cost per QALY gained was \u00a347,861, with the additional cost arising from increased time on disease-modifying therapies (DMTs). Cost-effectiveness of anti-drug antibody testing was sensitive to anti-drug antibody development risk, their impact on drug efficacy, and costs of disease-modifying therapies (DMTs). Anti-drug antibody testing to inform MS treatment switching could improve clinical outcomes, but its cost-effectiveness depends on anti-drug antibody risk, its impact on drug efficacy, and costs of DMTs.<\/jats:p>","DOI":"10.1007\/s10198-025-01854-8","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T11:03:14Z","timestamp":1762945394000},"page":"869-879","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term effectiveness and cost-effectiveness of testing for alemtuzumab antidrug antibodies to guide treatment in multiple sclerosis: a modelling study"],"prefix":"10.1007","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6557-8888","authenticated-orcid":false,"given":"Timothy","family":"Jamieson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Tomini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharmilee","family":"Gnanapavan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borislava","family":"Mihaylova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"1854_CR1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13819","author":"R Dobson","year":"2018","unstructured":"Dobson, R., Giovannoni, G.: Multiple sclerosis \u2013 a review. 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SG declares: Grants or contracts: Sanofi-Genzyme, Merck, Takeda, UK MS Society, NMSS, NIHR, NHS Digital. Consulting fees: Merck, Sanofi-Genzyme, Novartis, Biogen Idec, Roche. Payment or honoraria: MS Academy, MS Research Australia, UK MS Society, CMSC, Novartis, Roche, Sanofi-Genzyme, Merck, TriMS, Janssen, Neurodiem, MS Shift. Support for meetings: Novarti, Merck, Sanofi-Genzyme, Biogen Idec. Leadership or fiduciary role: UK PD and MS Society Brain Bank.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"For the purpose of open access, the authors have applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Rights retention statement"}}]}}