The cost-effectiveness of a bimekizumab versus IL-17A inhibitors treatment-pathway in patients with active axial spondyloarthritis in Scotland

Abstract

Objective

To estimate the cost-effectiveness of a treatment-pathway initiated with bimekizumab, a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F and IL-17A, in patients with axial spondyloarthritis (axSpA) compared with IL-17Ai's, ixekizumab, and secukinumab, from the NHS Scotland perspective.

Methods

The axSpA treatment-pathway was modeled using a decision tree followed by a lifetime Markov model. The pathway included first- and second-line biologic disease-modifying antirheumatic drugs (bDMARD), followed by best supportive care (bDMARD, nonbiologic). Bimekizumab followed by any bDMARD (“BKZ”) was compared with IL-17Ai’s: secukinumab 150 mg followed by a blend (“SEC”) of dose up-titration to secukinumab 300 mg and any bDMARD, or ixekizumab followed by any bDMARD (“IXE”). Transition to the next therapy was triggered by Bath Ankylosing Spondylitis Disease Activity Index-50% (BASDAI50) non-response or any-cause discontinuation. A published network meta-analysis provided efficacy data. EuroQoL-5-dimensions utilities were derived by mapping from Ankylosing Spondylitis Disease Activity Score. Costs included disease management (linked to functional limitations), biologics acquisition (list prices), administration and monitoring (NHS 2021/22). Discounting was 3.5%/year. Probabilistic results from patients with non-radiographic axSpA and ankylosing spondylitis were averaged to reflect the axSpA disease spectrum. Scenario and sensitivity analyses were performed.

Results

The incremental cost-effectiveness ratio (ICER) of BKZ was £24,801/quality-adjusted life-year (QALY) vs. SEC (95% credible interval £24,163–£25,895). BKZ had similar costs (Δ -£385 [−£15,239–£14,468]) and QALYs (Δ 0.039 [−0.748–0.825]) to IXE, with £1,523 (£862–£2,222) net monetary benefit. Conclusions remained unchanged in most scenarios. Results’ drivers included BASDAI50 response rate and disease management cost.

Limitations

Results were based on list prices. Data concerning up-titration to secukinumab 300 mg was scarce.

Conclusions

The bimekizumab treatment-pathway represents a cost-effective option across the axSpA disease spectrum in Scotland. Bimekizumab is cost-effective compared to a secukinumab-pathway that includes dose up-titration, and has similar costs and QALYs to an ixekizumab-pathway.

Keywords:

• Axial spondyloarthritis
• bimekizumab
• secukinumab
• ixekizumab
• cost-effectiveness
• Scotland NHS
• treatment-pathway

JEL CLASSIFICATION CODES:

• I10
• I1
• I
• I19

Transparency

Declaration of financial/other relationships

HT: Owns shares in Clifton Insight which has received consulting fees from UCB Pharma, Novartis, Pfizer, Roche, Eisai, Lundbeck, Argenx, Amicus, Merck, Daiichi-Sankyo, and Janssen. DW, MFM, MR, NL, VT: Employees of UCB Pharma. ML: independent consultant with no conflicts of interest to disclose. LG: Employee of IQVIA. Peer reviewers on this manuscript have received an honorarium from JME for their review work but have no other relevant financial relationships to disclose.

Author contributions

MM early model concept; VT: analyzed the data to provide model inputs; LG: searched literature, drafted the paper, programmed the model and ran the analyses; ML: model concept and inputs validation; NL: Late-stage analyses and developments; MR: model concept, analysis, interpretation, writing; HT: concept and analyses validation. All co-authors reviewed and contributed to the content.

Acknowledgements

The authors would like to thank the Scottish experts for their participation to the advisory board. The authors also thank Celia Menckeberg, UCB Pharma (The Netherlands) for publication coordination and editorial assistance, and Saurabh Trikha for his medical writing assistance during the preparation of this manuscript.

Additional information

Funding

This work was supported by UCB Pharma.