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

Figures & data

Figure 1. Markov model structure with 3-month induction period.

Table 1. Drug acquisition costs for biologics for AS patients in Canada.

Administration	Drug	Dose (mg)	Cost (CAD)
Subcutaneous	Secukinumab	150	822.50
	Adalimumab	40	769.97
	Certolizumab	200	664.51
	Etanercept	50	405.99
	Etanercept biosimilar	50	255.00
	Golimumab	50	1,555.17
Intravenous	Infliximab	100	987.56
	Infliximab biosimilar	100	525.00

AS, Ankylosing spondylitis; CAD, Canadian dollar; mg, milligrams.

Drug acquisition costs were obtained from the Ontario drug benefit formulary/comparative drug index²⁹.

Table 2. Summary of ICER results for secukinumab vs biologics by varying base-case assumptions.

Parameters	Base case	Alternative scenarios	Secukinumab 150 mg
Subpopulation	Biologic-naïve	Mixed (a combination of biologic-naïve and biologic-experienced) sub-population	Similar to base case^a
BASFI rebound assumption	Natural history	Initial gain (BASFI deteriorates by the amount of improvement that was achieved during response to therapy)	Similar to base case^a
Disutilities	Not included	Disutilities for adverse events included	Similar to base case^a
Utilities	Measure 1 and 2 trial data	Using McLeod et al.^35	Similar to base case^a

ICER, Incremental cost-effectiveness ratio; BASFI, Bath Ankylosing Spondylitis Functional Index.

^a Secukinumab dominates all biologics.

Table 3. Total costs, QALYs for biologic-naïve AS patients over a lifetime horizon (60 years).

Administration	Drug	Total cost (CAD)	QALYs	Secukinumab vs comparator
Subcutaneous	Secukinumab	533,010	16.46
	Adalimumab	594,597	15.61	Secukinumab dominates adalimumab
	Certolizumab pegol	586,732	15.78	Secukinumab dominates certolizumab
	Etanercept	585,755	15.19	Secukinumab dominates etanercept
	Etanercept biosimilar	574,062	15.19	Secukinumab dominates etanercept biosimilar
	Golimumab	588,053	16.13	Secukinumab dominates golimumab
Intravenous	Infliximab	622,244	15.74	Secukinumab dominates infliximab
	Infliximab biosimilar	577,551	15.74	Secukinumab dominates infliximab biosimilar

AS, Ankylosing spondylitis; CAD, Canadian dollar; ICER, Incremental cost-effectiveness ratio; QALY, Quality-adjusted life years.

Table 4. Costs and QALYs breakdown.

	Secukinumab	Certolizumab pegol	Etanercept	Adalimumab	Infliximab	Golimumab
Costs (CAD)
Biologic drug costs	308,218	340,489	331,221	347,550	373,433	351,304
Disease related costs	213,054	232,497	242,684	233,914	235,363	224,575
Monitoring	4,760	4,597	4,471	4,558	4,522	4,652
Serious infection	6,092	8,119	6,272	6,984	7,414	6,377
Malignancy	886	1,030	1,107	1,592	1,512	1,146
Total	533,010	586,732	585,755	594,597	622,244	588,053
QALYs
Disease-related QALYs	16.462	15.788	15.199	15.614	15.749	16.137
Disutilities	–0.004	–0.005	–0.004	–0.004	–0.005	–0.004
Total	16.458	15.783	15.195	15.610	15.745	16.133

CAD, Canadian dollar; QALY, Quality-adjusted life years.

Figure 2. Probability of net monetary benefit of AS treatments at different willingness-to-pay thresholds. NMB, Net monetary benefit; SEC, secukinumab; ADA, adalimumab; CER P, certolizumab pegol; ETN, etanercept; GOL, golimumab; INF, infliximab.

Figure 3. Cost-effectiveness scatter plot. ADA, adalimumab; CAD, Canadian dollar; CE, cost-effectiveness; CER P, certolizumab pegol; ETN, etanercept; GOL, golimumab; INF, infliximab; SEC, secukinumab; QALYs, quality adjusted life years.

McLeod C, Bagust A, Boland A, et al. Adalimumab, etanercept and infliximab for the treatment of ankylosing spondylitis: a systematic review and economic evaluation [Review]. Health Technol Assess 2007;11:1–158, iii–iv

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