Elsevier

Value in Health Regional Issues

Volume 20, December 2019, Pages 86-94
Value in Health Regional Issues

Economic Evaluation
Cost-Effectiveness of Secukinumab Versus Other Biologics in the Treatment of Psoriatic Arthritis: An Argentinean Perspective

https://doi.org/10.1016/j.vhri.2019.03.002Get rights and content
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Highlights

  • Introduction of biologics in the treatment of psoriatic arthritis has significantly altered the treatment paradigm, leading to better disease management and improvement in the quality of life of patients.

  • Biologic treatments are costly and hence it is important to evaluate the cost-effectiveness of these treatments considering the finite healthcare resources.

  • Multiple cost-effectiveness studies and multiple technology assessments have evaluated the impact of biologic treatments (adalimumab, golimumab, etanercept, certolizumab pegol, ustekinumab, and infliximab) in active psoriatic arthritis patients in many countries.

  • This is the first-ever study that assessed the cost-effectiveness of secukinumab in psoriatic arthritis in Argentina.

  • For both biologic-naïve and experienced patients, secukinumab at 150- and 300-mg doses was either a dominant or cost-effective treatment option compared with other biologics.

Abstract

Objective

Psoriatic arthritis (PsA) is a chronic, systemic inflammatory disease. This study assessed the cost-effectiveness of secukinumab, an interleukin-17A inhibitor, versus other biologics in PsA from the Argentinean social security perspective.

Methods

A semi-Markov model evaluated subcutaneous (sc) treatment with secukinumab 150 mg and 300 mg against other sc treatments such as adalimumab, certolizumab pegol, etanercept, golimumab, ustekinumab, and intravenous treatment infliximab in biologic-naïve (with or without moderate to severe psoriasis) and biologic-experienced PsA patients over a lifetime horizon. Response to treatments was determined using the PsA Response Criteria (PsARC) at 12 weeks. Model inputs were derived from randomized controlled trials, network meta-analyses, published literature, and other Argentinean sources. Model outcomes included quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratios. Sensitivity analyses and alternative scenarios with a higher cost option were also conducted.

Results

Among biologic-naïve PsA patients without psoriasis, secukinumab 150 mg provided the highest QALYs (7.18) versus all sc biologics at the lowest cost ($3 755 678 Argentine peso), thus dominating them. Among biologic-naïve PsA patients with psoriasis and biologic-experienced PsA patients, secukinumab 300 mg provided highest QALYs (6.99 and 7.53, respectively), dominated infliximab, and was cost-effective versus other sc biologics. Deterministic sensitivity analyses indicated sensitivity of results to variation in PsARC rates, drug acquisition costs, Health Assessment Questionnaire change, and utilities. A probabilistic sensitivity analysis showed maximum net monetary benefits with both secukinumab doses. Results from an alternative scenario analysis were similar to base-case analysis.

Conclusions

For both biologic-naïve and experienced PsA patients, secukinumab is either a dominant or cost-effective treatment option compared with other biologics in Argentina.

Keywords

secukinumab
psoriatic arthritis
cost-effectiveness
Argentina
interleukin-17A inhibitor
tumor necrosis factor inhibitors
incremental cost-effectiveness ratio
quality-adjusted life year

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Conflict of interest: The authors have indicated that they have no conflicts of interest with regard to the content of this article.