Cost-effectiveness analysis of secukinumab versus other biologics and apremilast in the treatment of active Psoriatic arthritis: a Finnish perspective

Abstract

ObjectiveTo study cost-effectiveness of an interleukin (IL)-17A inhibitor secukinumab, with other biologics and apremilast in patients with Psoriatic arthritis (PsA) from payer perspective in Finland.MethodsIn this semi-Markov model, subcutaneous (SC) secukinumab was compared with SC treatments etanercept and its biosimilar, certolizumab pegol, adalimumab and its biosimilar, golimumab, ustekinumab, intravenous (IV) treatment infliximab, as well as oral non-biologic apremilast. Patients without prior exposure (naïve) to biologics and without moderate to severe psoriasis were considered for secukinumab 150 mg group. Secukinumab 300 mg group included naïve patients with moderate to severe psoriasis and all patients with prior biologic exposure. The PsA Response Criteria (PsARC) at 12-week was primary criteria for treatment response. Other clinical as well as cost related model inputs were derived from relevant clinical trials as well as Finnish publications. The key model outcomes were quality-adjusted life years and incremental cost-effectiveness ratio. An annual 3% discount rate was applied to all future costs and benefits. Model input variations were assessed through sensitivity analyses and alternative scenario analyses.ResultsFor a lifetime horizon (60 years), secukinumab 150 mg dominated all branded SC biologics and apremilast with highest QALY of 8.01 and lowest lifetime cost of €187,776, while it was cost-effective against IV infliximab among biologic-naïve patients without moderate to severe psoriasis. Secukinumab 300 mg was cost-effective against all branded SC biologics and apremilast and dominated IV infliximab among biologic-naïve patients with moderate to severe psoriasis, while it was cost-effective in biologic experienced patients. With the one-way sensitivity analysis, PsARC response, drug acquisition cost, and health assessment questionnaire score were the most important parameters affecting the outcomes. Across all treatment groups, patients on secukinumab were most likely to achieve highest net monetary benefit than other competitors in probabilistic sensitivity analysis. With alternative scenario analysis, results largely remained unchanged.ConclusionsSecukinumab is a cost-effective treatment for PsA patients from a Finnish payer’s perspective.Electronic supplementary materialThe online version of this article (10.1186/s12962-018-0162-3) contains supplementary material, which is available to authorized users.

Cost per Responder Analysis of Secukinumab versus Adalimumab in the Treatment of Psoriatic Disease

“…Conversely, an Argentinian cost-effectiveness analysis over a lifetime horizon of secukinumab versus other biologics for the treatment of PsA found that among biologic-naïve PsA patients without psoriasis, secukinumab dominated adalimumab, while among those biologic-naïve with psoriasis and those biologic-experienced, secukinumab was cost effective versus adalimumab [ 23 ]. Similarly, a Finnish cost-effectiveness analysis over a lifetime horizon of secukinumab versus other biologics in PsA found that secukinumab dominated adalimumab in biologic-naïve patients without moderate to severe psoriasis, while it was cost effective against adalimumab in biologic-naïve patients with moderate to severe psoriasis and biologic experienced patients [ 24 ]. Secukinumab also dominated adalimumab for the treatment of PsA in a Canadian cost-effectiveness analysis over a lifetime perspective that included both biologic-naïve and biologic-experienced patients [ 25 ].…”

Mini Review: New Treatments in Psoriatic Arthritis. Focus on the IL-23/17 Axis

“…Secukinumab greatly improved nail psoriasis, as assessed by NAPSI (Reich et al, 2018). Secukinumab was a cost-effective biological in the treatment of PsA with the highest net monetary benefit than other biologicals in Finland (Purmonen et al, 2018).…”