Cost-effectiveness analysis of secukinumab for the treatment of active psoriatic arthritis: a Canadian perspective

Abstract

Objective: The study evaluates the cost-effectiveness of secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin (IL)-17A, vs currently licensed biologic treatments in patients with active psoriatic arthritis (PsA) from a Canadian healthcare system perspective.

Methods: A decision analytic semi-Markov model evaluated the cost-effectiveness of secukinumab 150 mg and 300 mg compared to subcutaneous biologics adalimumab, certolizumab pegol, etanercept, golimumab, and ustekinumab, and intravenous biologics infliximab and infliximab biosimilar in biologic-naive and biologic-experienced patients over a lifetime horizon. The response to treatments was evaluated after 12 weeks by PsA Response Criteria (PsARC) response rates. Non-responders or patients discontinuing initial-line of biologic treatment were allowed to switch to subsequent-line biologics. Model input parameters (Psoriasis Area Severity Index [PASI], Health Assessment Questionnaire [HAQ], withdrawal rates, costs, and resource use) were collected from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). An annual discount rate of 5% was applied to costs and benefits. The robustness of the study findings were evaluated via sensitivity analyses.

Results: Biologic-naive patients treated with secukinumab achieved the highest number of QALYs (8.54) at the lowest cost (CAD 925,387) over a lifetime horizon vs all comparators. Secukinumab dominated all treatments, except for infliximab and its biosimilar, which achieved minimally more QALYs (8.58). However, infliximab and its biosimilar incurred more costs than secukinumab (infliximab: CAD 1,015,437; infliximab biosimilar: CAD 941,004), resulting in higher cost-effectiveness estimates relative to secukinumab. In the biologic-experienced population, secukinumab dominated all treatments as it generated more QALYs (8.89) at lower costs (CAD 954,692). Deterministic sensitivity analyses indicated the results were most sensitive to variation in PsARC response rates, change in HAQ, and utility values in both populations.

Conclusions: Secukinumab is either dominant or cost-effective vs all licensed biologics for the treatment of active PsA in biologic-naive and biologic-experienced populations in Canada.

Keywords:

• Secukinumab
• psoriatic arthritis
• cost-effectiveness
• Canada
• biologics
• tumor necrosis factor inhibitors
• incremental cost effectiveness ratio (ICER)
• quality-adjusted life year (QALY)
• biosimilars

Transparency

Declaration of funding

This study was funded by Novartis Pharma AG, Basel, Switzerland.

Declaration of financial/other interests

RG is a consultant for Novartis. DG has received grant/research support from Abbvie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, and UCB and is a consultant for Abbvie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, and UCB. SC is an employee of Novartis Pharmaceuticals Canada Inc., Dorval, Canada. PG is an employee of Novartis Product Life Cycle Services-NBS, Novartis Healthcare Private Limited, Hyderabad, India. CNG and LM are employees of RTI Health Solutions, Research Triangle Park, USA. EN is an employee of Novartis Product Lifecycle Services–NBS, Novartis Global Service Center Dublin, Ireland. SMJ is an employee and shareholder of Novartis Pharma AG, Basel, Switzerland. Peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

The authors thank Niraj Modi, Novartis Healthcare Private Limited, Hyderabad, India for editorial writing support and Doreen McBride and Tina Krieger from RTI Health Solutions for project management support during the model development phase.