Cost-effectiveness analysis of secukinumab in ankylosing spondylitis from the Canadian perspective

Abstract

Aim: To assess the cost-effectiveness of interleukin (IL)-17A inhibitor secukinumab vs the currently licensed biologic therapies in ankylosing spondylitis (AS) patients from a Canadian healthcare system perspective. Methods: A decision analytic model (semi-Markov) evaluated the cost-effectiveness of secukinumab 150 mg compared to certolizumab pegol, adalimumab, golimumab, etanercept and etanercept biosimilar, and infliximab and infliximab biosimilar in a biologic-naïve population, over 60 years of time horizon (lifetime). The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI 50) response rate was used to assess treatment response at week 12. Non-responders or patients discontinuing initial-line of biologic therapy were allowed to switch to subsequent-line biologics. Model input parameters (short-term and long-term changes in BASDAI and Bath Ankylosing Spondylitis Functional Index [BASFI], withdrawal rates, adverse events, costs, resource use, utilities, and disutilities) were obtained from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). Cost and benefits were discounted with an annual discount rate of 1.5% for all treatments. Results: In the biologic-naïve population, secukinumab 150 mg dominated all comparators, as patients treated with secukinumab 150 mg achieved the highest QALYs (16.46) at the lowest cost (CAD 533,010) over a lifetime horizon vs comparators. In the deterministic sensitivity analysis, results were most sensitive to changes in baseline BASFI non-responders, BASDAI 50 at 3 months and discount rates. Probabilistic sensitivity analysis showed that secukinumab 150 mg demonstrated higher probability of achieving maximum net monetary benefit vs all comparators at various cost thresholds. Conclusions: This analysis demonstrates that secukinumab 150 mg is the most cost-effective treatment option for biologic-naïve AS patients compared to certolizumab pegol, adalimumab, golimumab, etanercept and etanercept biosimilar, and infliximab and infliximab biosimilar for a lifetime horizon in Canada. Treatment with secukinumab translates into substantial benefits for patients and the healthcare system.

<p>Cost-effectiveness of secukinumab compared to other biologics in the treatment of ankylosing spondylitis in Finland</p>

“…This is among the first full-length studies assessing cost-effectiveness of secukinumab 150 mg compared with other biologics. However, other modeling studies have been conducted in different countries such as Canada,34 UK,35,36 Turkey,37 Colombia,38 Bulgaria,39 and Russia;40 which reported similar results. All these studies reported secukinumab to be dominant (more effective and less costly) over anti-TNFs in biologic-naïve as well as biologic-experienced AS population.…”

“…All these studies reported secukinumab to be dominant (more effective and less costly) over anti-TNFs in biologic-naïve as well as biologic-experienced AS population. Across multiple studies, secukinumab resulted in an additional 0.20–0.86 QALY gain at a total cost, which was €4,644 to €9,134 lower compared with other biologics 34,37,38. The current study is also the first to assess cost-effectiveness of secukinumab in a Finnish context.…”

A cost per responder analysis of secukinumab vs adalimumab for the treatment of ankylosing spondylitis from the Korean perspective

“…According to reimbursement guidelines of Korea, secukinumab is classified as a secondary biologic agent to be used in AS patients who had inadequate response or adverse reactions to TNFis. As shown in Table , an economic analysis documented cost‐effectiveness of secukinumab in biologic‐naïve patients with AS in various countries . However, applying 1 country's results to another is not appropriate due to the differences in terms of healthcare systems and healthcare cost in each country.…”

“…As shown in Table 3, an economic analysis documented cost-effectiveness of secukinumab in biologic-naïve patients with AS in various countries. [18][19][20][21][22][23][24] However, applying 1 country's results to another is not appropriate due to the differences in terms of healthcare systems and healthcare cost in each country. Therefore, we analyzed the cost per responder of secukinumab from the Korean perspective based on the ASAS according to Korean healthcare costs.…”

“…Several studies comparing the cost-effectiveness of secukinumab and TNFi in AS treatment have been published from various countries. [18][19][20][21][22][23][24] All of them showed that secukinumab is a cost-effective treatment option for active AS, regardless of experience with a biologic agent. [18][19][20][21][22][23][24] Cost per responder of ASAS 20 and ASAS 40 were almost half compared with other TNFis in most of the countries.…”