Cost-effectiveness of secukinumab compared to other biologics in the treatment of ankylosing spondylitis in Finland

Figures & data

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

Abbreviations: Tx, treatment; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index.

Table 1 BASDAI 50 response at 3 months in biologic-naïve patients

Administration	Treatment	Biologic-naïve
Subcutaneous	Secukinumab	41.53%
	Certolizumab pegol	44.20%
	Etanercept	36.80%
	Adalimumab	48.85%
	Golimumab	47.20%
Intravenous	Infliximab	44.20%

Notes: BASDAI 50 response data are from a Bayesian fixed effects network meta-analysis.²² Biologic-naïve data for certolizumab pegol and infliximab were not available and were assumed equivalent to average of other biologics in the network meta-analysis

Abbreviation: BASDAI, Bath Ankylosing Spondylitis Disease Activity Index.

Table 2 Short-term changes in BASDAI and BASFI in biologic-naïve patients

Measure	Patient group	SEC	CER P	ETN	ADA	INF	GOL
Change in BASDAI	Respondersa	−4.60	−5.57	−4.47	−4.56	−7.94	−5.32
	Nonresponders	−1.01	−1.28	−1.02	−0.81	−1.82	−1.37
Change in BASFI	Responders	−3.75	−3.59	−3.44	−3.15	−3.96	−4.07
	Nonresponders	−1.17	−0.89	−0.85	−0.78	−0.98	−0.71

Notes: Bayesian fixed effects network meta-analysis.²²

a Responders are those who showed BASDAI 50 response. Change in BASDAI data for biologic-naïve patients was not available for SEC and CER P and was assumed to be equivalent to the average of other biologics in the NMA. Change in BASFI data for biologic-naïve patients for CER P was not available and was assumed to be equivalent to the average of other biologics in the NMA (excluding SEC).

Abbreviations: ADA, adalimumab; AS, ankylosing spondylitis; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; CER P, certolizumab pegol; ETN, etanercept; GOL, golimumab; INF, infliximab; NMA, network meta-analysis; SEC, secukinumab.

Table 3 Long-term changes in BASFI

Input	Mean	Sources
Annual rate of mSASSS change for mSASSS ≥10	1.440	Corbett et al (2014)^Citation28
BASFI change associated with 1 unit change in mSASSS	0.057	Corbett et al (2014)^Citation28
Biologic treatment effect on progression for comparators	0.420	Corbett et al (2014)^Citation28
Biologic treatment effect on progression for secukinumaba	0.153	Calculated from MEASURE 1 trial data and using overall background progress rate from Ramiro et al (2015)^Citation50
Time to treatment effect (years)	0	Assumption

Notes: The long-term changes in BASFI were assessed by progression of radiographic disease measured by mSASSS score.

a This figure was calculated using the overall background progression rate of 0.98 units/year from the study by Ramiro et al (2015)⁵⁰ and the MEASURE 1 week 104 mSASSS progression figure of 0.3.

Abbreviations: BASFI, Bath Ankylosing Spondylitis Functional Index; mSASSS, modified Stoke Ankylosing Spondylitis Spine Score.

Table 4 Drug acquisition costs for biologics in Finland

Administration	Drug	Dose (mg)	Cost	Unit	Number of doses (first 3 months)
Subcutaneous	Secukinumab	150	€584.43	Per prefilled syringe	7.00
	Certolizumab pegol	200	€483.07	Per prefilled syringe	10.00
	Etanercept	50	€260.04	Per prefilled syringe	13.00
	Etanercept biosimilar	50	€182.02	Per prefilled syringe	13.00
	Adalimumab	40	€527.41	Per prefilled syringe	7.00
	Adalimumab biosimilar	40	€369.19	Per vial	7.00
	Golimumab	50	€1,086.93	Per prefilled syringe	3.00
Intravenous	Infliximab	100	€436.06	Per vial	3.00

Notes: Finnish medicinal products and price database.²⁷ All prices exclude value added tax. Retail price for s.c. products and wholesale price for i.v. products are applied according to local guidelines. Infliximab price was calculated as a weighted average according to market shares of originator drug and biosimilars. Additionally, a cost of €382 (2016 value) was considered for each i.v. administration.⁵¹ Biosimilar pricing for etanercept and adalimumab was assumed to be 30% less than brand; they are not available in the market and thus, only used for sensitivity analysis.

Abbreviations: i.v., intravenous; s.c., subcutaneous.

Table 5 Health outcomes, direct costs, and ICER for secukinumab 150 mg vs comparators over a lifetime horizon (60 years)

Administration	Treatment	Total state (€)	QALYs	Time spent in BASDAI 50 responder state (in years)	ICER costs (secukinumab vs comparator)
Subcutaneous	Secukinumab	279,872	13.1	27.9
	Certolizumab pegol	309,257	12.6	26.7	Secukinumab dominates
	Etanercept	305,883	12.1	25.9	Secukinumab dominates
	Etanercept biosimilar	300,075	12.1	25.9	Secukinumab dominates
	Adalimumab	312,139	12.5	26.5	Secukinumab dominates
	Adalimumab biosimilar	297,282	12.5	26.5	Secukinumab dominates
	Golimumab	309,551	12.9	27.1	Secukinumab dominates
Intravenous	Infliximab	316,291	12.6	26.2	Secukinumab dominates

Abbreviations: BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; ICER, Incremental cost-effectiveness ratio; QALYs, quality-adjusted life years.

Figure 2 Probability of cost-effectiveness of AS treatments at different willingness-to-pay thresholds for biologic-naïve patients.

Abbreviations: ADA, adalimumab; AS, ankylosing spondylitis; CER P, certolizumab pegol; ETN, etanercept; GOL, golimumab; INF, infliximab; SEC, secukinumab.

Table 6 Alternative scenario analyses: cost-effectiveness results for secukinumab vs other biologics by varying base-case assumptions

Parameters	Base case	Scenarios tested	Results
Population	Biologic naïve	Biologic-naïve and biologic- experienced population	Similar to base casea
Utility	MEASURE 1 and 2 trial data	McLeod et al (2007)^Citation33	Similar to base casea
Disutility	Not included	Included	Similar to base casea
BASFI rebound assumptionb	Natural history	Initial gain	Similar to base casea
Indirect costs	Not included	Included	Secukinumab dominates all branded biologics and was cost-effective against biosimilars
Disease-specific costs	Included	Excluded	Similar to base casea

Notes:

a Similar to base-case results, means secukinumab 150 mg dominates all its comparator with higher QALYs and lower costs.

b BASFI can be assumed to deteriorate in two ways: 1) rebound equal to gain: BASFI deteriorates by the same amount by which it improved when they responded to therapy; 2) rebound back to natural history: BASFI deteriorates to the level and subsequent trajectory it would have been had they not initially responded to therapy. Detailed results for all scenarios are available in supplementary materials (Tables S12–S17).

Abbreviations: BASFI, Bath Ankylosing Spondylitis Functional Index; QALYs, quality-adjusted life years.

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