{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T22:49:30Z","timestamp":1782341370273,"version":"3.54.5"},"reference-count":29,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T00:00:00Z","timestamp":1717977600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004334","name":"Merck","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004334","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Uncertainty about disproportionate impact on health care budgets limits implementation of early highly effective treatment (EHT) in multiple sclerosis (MS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To estimate cost-effectiveness of escalation versus EHT disease-modifying treatment (DMT) sequences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Using a health-economic approach, we analysed health benefits (relapse rate reduction, disability prevention), direct\/indirect DMT and societal costs of escalation versus EHT DMT sequences. In scenario analyses, we allowed (1) earlier use of alemtuzumab (ALE) and (2) a single retreatment with cladribine (CLA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In our model, we showed that the ratio between costs and quality-adjusted life years (QALYs) for the most cost-effective EHT and escalation sequence results into a similar net health benefit with higher costs and also higher QALYs associated with an EHT versus escalation strategy. Earlier use of ALE is more cost-effective than in later lines, even when aggravating the impact of its side-effects tenfold. Retreatment with CLA was more cost-effective in both escalation and EHT sequences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Certain EHT sequences are equally cost-effective to escalation sequences and are likely to result in more health at uncertain additional costs. The favourable cost\u2013benefit ratio of CLA and ALE suggests that a wider application of affordable highly effective therapies could promote the cost-effectiveness both EHT and escalation approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585241258692","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T01:46:36Z","timestamp":1718070396000},"page":"1016-1025","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Benefits of early highly effective versus escalation treatment strategies in relapsing multiple sclerosis estimated using a treatment-sequence model"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8174-2898","authenticated-orcid":false,"given":"Ide","family":"Smets","sequence":"first","affiliation":[{"name":"MS Center ErasMS, Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthijs","family":"Versteegh","sequence":"additional","affiliation":[{"name":"Huygens & Versteegh, Zwijndrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Huygens","sequence":"additional","affiliation":[{"name":"Huygens & Versteegh, Zwijndrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2616-8464","authenticated-orcid":false,"given":"Beatrijs","family":"Wokke","sequence":"additional","affiliation":[{"name":"MS Center ErasMS, Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9766-8661","authenticated-orcid":false,"given":"Joost","family":"Smolders","sequence":"additional","affiliation":[{"name":"MS Center ErasMS, Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands"},{"name":"MS Center ErasMS, Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands"},{"name":"Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,6,10]]},"reference":[{"key":"bibr1-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2023.2208347"},{"key":"bibr2-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-023-01942-0"},{"key":"bibr3-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2021.2738"},{"key":"bibr4-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2018.4905"},{"key":"bibr5-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1177\/13524585211010128"},{"key":"bibr6-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-022-11193-w"},{"key":"bibr7-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000636"},{"key":"bibr8-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000201645"},{"key":"bibr9-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000200150"},{"key":"bibr10-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2021.05.020"},{"key":"bibr11-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2021.11.1363"},{"key":"bibr12-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2023.105100"},{"key":"bibr13-13524585241258692","volume-title":"Richtlijn voor het uitvoeren van economische evaluaties in de gezondheidszorg","author":"Zorginstituut Nederland","year":"2016"},{"key":"bibr14-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-058279"},{"key":"bibr15-13524585241258692","unstructured":"World Health Organization (WHO). The selection and use of essential medicines 23rd list, 2023. WHO technical report series, https:\/\/www.who.int\/publications\/i\/item\/WHO-MHP-HPS-EML-2023.02"},{"issue":"3","key":"bibr16-13524585241258692","volume":"9","author":"Smets I","year":"2023","journal-title":"Mult Scler J Exp Transl Clin"},{"key":"bibr17-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2022.5007"},{"key":"bibr18-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-021-10836-8"},{"key":"bibr19-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61769-3"},{"key":"bibr20-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61768-1"},{"key":"bibr21-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000005409"},{"key":"bibr22-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-020-00191-7"},{"key":"bibr23-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2022.104459"},{"key":"bibr24-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1080\/14656566.2022.2106783"},{"key":"bibr25-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-022-00339-7"},{"key":"bibr26-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2018.1461630"},{"key":"bibr27-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1080\/14737167.2019.1635014"},{"key":"bibr28-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1177\/13524585221109386"},{"key":"bibr29-13524585241258692","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2020.102279"}],"container-title":["Multiple Sclerosis Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13524585241258692","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/13524585241258692","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13524585241258692","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T04:15:27Z","timestamp":1777695327000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/13524585241258692"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,10]]},"references-count":29,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1177\/13524585241258692"],"URL":"https:\/\/doi.org\/10.1177\/13524585241258692","relation":{},"ISSN":["1352-4585","1477-0970"],"issn-type":[{"value":"1352-4585","type":"print"},{"value":"1477-0970","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,10]]}}}