{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:18:28Z","timestamp":1792685908942,"version":"4.5.0"},"reference-count":44,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Neurol Disord"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Disease-modifying therapies (DMTs) have transformed multiple sclerosis (MS) care but are associated with substantial costs. Among high-efficacy DMTs, anti-CD20 antibodies are widely used, yet their economic value, particularly compared with different classes of DMTs, has not been comprehensively synthesized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To systematically review evidence on the cost-effectiveness of anti-CD20 antibodies compared with other DMTs or best supportive care (BSC) in MS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources and methods:<\/jats:title>\n                    <jats:p>\n                      We searched\n                      <jats:italic toggle=\"yes\">PubMed<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">Embase<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">Web of Science<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">International Network of Agencies for Health<\/jats:italic>\n                      Technology\n                      <jats:italic toggle=\"yes\">Assessment<\/jats:italic>\n                      (July 2025) for cost-effectiveness analyses comparing rituximab, ocrelizumab, ofatumumab, or ublituximab with other DMTs or BSC. Two reviewers independently screened studies, extracted data, and assessed reporting quality using the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. All costs were converted to 2024 US dollars and adjusted for inflation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 92 records screened, 20 studies met inclusion criteria. Analyses were conducted in diverse but mostly high-income regions, most commonly using Markov models with long time horizons. Anti-CD20 antibodies were dominant (more effective, less costly) or cost-effective in the majority of studies, particularly when compared with platform therapies. In contrast, comparisons with other high-efficacy DMTs yielded more heterogeneous results, with immune reconstitution therapies more cost-effective in several studies. Reporting quality was generally high, although patient involvement, assessment of heterogeneity, and a health economic analysis plan were rarely addressed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>These findings support the use of anti-CD20 antibodies as an economically reasonable option in many healthcare settings, particularly when compared with platform therapies, while underscoring that cost-effectiveness relative to other high-efficacy treatments is context-dependent. The lack of data from low- and middle-income countries and limited transparency in Health Technology Assessment reports represent major limitations. Future research should prioritize context-specific evaluations and promote full disclosure of economic data to strengthen the evidence base for clinically and economically informed reimbursement decisions in MS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>The study was prospectively registered with PROSPERO (ID: CRD420251109958).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562864261426816","type":"journal-article","created":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T04:03:51Z","timestamp":1774757031000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Economic value of anti-CD20 therapies in multiple sclerosis: a systematic review of cost-effectiveness studies"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5476-9987","authenticated-orcid":false,"given":"Johannes","family":"Heinemann","sequence":"first","affiliation":[{"name":"Medical Center, Department of Neurology and Neurophysiology, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, Freiburg 79106, Germany Johannes"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Zirkel","sequence":"additional","affiliation":[{"name":"Department of Health Care Management, Law and Economics Faculty of the Friedrich-Alexander University of Erlangen\u2013Nuremberg, Nuremberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Schoeffski","sequence":"additional","affiliation":[{"name":"Department of Health Care Management, Law and Economics Faculty of the Friedrich-Alexander University of Erlangen\u2013Nuremberg, Nuremberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick","family":"Dersch","sequence":"additional","affiliation":[{"name":"Medical Center, Department of Neurology and Neurophysiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinz","family":"Wiendl","sequence":"additional","affiliation":[{"name":"Medical Center, Department of Neurology and Neurophysiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00038-3"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2020.102162"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000200150"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.26858"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.57264\/cer-2023-0016"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-021-01118-x"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-017-0577-2"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.1015256"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2024.106161"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13561-024-00478-7"},{"key":"e_1_3_5_12_2","unstructured":"Heinemann J Zirkel M. Cost-effectiveness of anti-CD20 antibodies in multiple sclerosis: a systematic review. PROSPERO 2025 CRD420251109958 https:\/\/www.crd.york.Ac.uk\/PROSPERO\/view\/CRD420251109958 (2025 accessed 11 August 2025)."},{"key":"e_1_3_5_13_2","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page MJ","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.","journal-title":"BMJ"},{"key":"e_1_3_5_14_2","author":"Akers J","year":"2009","unstructured":"Akers J, Aguiar-Ib\u00e1\u00f1ez R, Baba-Akbari A. Systematic reviews: CRD\u2019s guidance for undertaking reviews in health care. Heslington, UK: University of York, 2009.","journal-title":"Systematic reviews: CRD\u2019s guidance for undertaking reviews in health care"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2021.10.008"},{"key":"e_1_3_5_16_2","volume-title":"Pharmacoeconomic report: Ofatumumab (Kesimpta): (Novartis Pharmaceuticals Canada Inc.): Indication: multiple sclerosis, relapsing-remitting","author":"Canadian Agency for Drugs and Technologies in Health","year":"2021","unstructured":"Canadian Agency for Drugs and Technologies in Health. Pharmacoeconomic report: Ofatumumab (Kesimpta): (Novartis Pharmaceuticals Canada Inc.): Indication: multiple sclerosis, relapsing-remitting. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health, 2021."},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-023-09462-z"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.2147\/CEOR.S503842"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26914"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph182413261"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-023-10099-1"},{"issue":"3","key":"e_1_3_5_22_2","first-page":"154","article-title":"Cost-effectiveness of ocrelizumab for treatment of Iranian patients with relapsing multiple sclerosis","volume":"20","author":"Ayati N","year":"2021","unstructured":"Ayati N, Taheri S, Sahraian MA, et al. Cost-effectiveness of ocrelizumab for treatment of Iranian patients with relapsing multiple sclerosis. Curr J Neurol 2021; 20(3): 154\u2013161.","journal-title":"Curr J Neurol"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s41669-022-00363-1"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2018.08.011"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s41669-021-00282-7"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2017.1357564"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/17562864251330260"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s41669-022-00381-z"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-025-01486-z"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2022.2078103"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vhri.2023.02.008"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-022-07495-4"},{"issue":"3","key":"e_1_3_5_33_2","article-title":"Health-economic benefits of anti-CD20 treatments in relapsing multiple sclerosis estimated using a treatment-sequence model","volume":"9","author":"Smets I","year":"2023","unstructured":"Smets I, Versteegh M, Huygens S, et al. Health-economic benefits of anti-CD20 treatments in relapsing multiple sclerosis estimated using a treatment-sequence model. Mult Scler J Exp Transl Clin 2023; 9(3): 20552173231189398.","journal-title":"Mult Scler J Exp Transl Clin"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2017.1355310"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-018-0566-9"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-020-01536-x"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2019.07.009"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-11969-8"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1177\/13524585211065711"},{"key":"e_1_3_5_40_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2024.0395"},{"key":"e_1_3_5_41_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-019-0268-z"},{"key":"e_1_3_5_42_2","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S134398"},{"key":"e_1_3_5_43_2","unstructured":"Hemmer B. Diagnose und therapie der multiplen sklerose Neuromyelitis-optica-spektrum-erkrankungen und MOG-IgG-assoziierten erkrankungen S2k-leitlinie www.dgn.org\/leitlinien (2023 accessed 11 January 2025)."},{"key":"e_1_3_5_44_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2005.03070.x"},{"key":"e_1_3_5_45_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1458458"}],"container-title":["Therapeutic Advances in Neurological Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17562864261426816","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17562864261426816","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17562864261426816","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T07:46:24Z","timestamp":1774943184000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17562864261426816"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":44,"alternative-id":["10.1177\/17562864261426816"],"URL":"https:\/\/doi.org\/10.1177\/17562864261426816","relation":{},"ISSN":["1756-2864","1756-2864"],"issn-type":[{"value":"1756-2864","type":"print"},{"value":"1756-2864","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"article-number":"17562864261426816"}}