Economic evaluation of adalimumab versus etanercept for psoriatic arthritis in a Brazilian real-world model

ABSTRACT

Background: TNF inhibitors are costly drugs supplied generally on health systems or private insurances. Performance analysis is essential to verify the results achieved by health technologies in these systems. The objective of the study was to compare the two most used biological drugs for the treatment of psoriatic arthritis (PsA) in Brazil.

Methods: A cost-utility analysis was built using a Markov model, with a five-year time horizon, a discount rate of 5%, and from the perspective of the Unified Health System. Deterministic and probabilistic sensitivity analyses were performed.

Results: Etanercept was the most cost-effective drug. Adalimumab became the most cost-effective drug in one of the four analysis scenarios with a willingness to pay from one gross domestic product per capita. The deterministic sensitivity analysis identified that the cost parameters had the greatest impact on the most effective drug. The probabilistic sensitivity analysis indicated that etanercept is the drug most likely to be cost-effective.

Conclusion: The difference between the drugs in terms of utility was minimal and the costs were the main factor that impacted the cost-utility ratio, which points to the benefits of price renegotiation for the efficient allocation of resources in the health system.

KEYWORDS:

• Adalimumab
• cost-utility analysis
• etanercept
• psoriatic arthritis

Article highlights

• Adalimumab and etanercept, the two most used biological drugs for the treatment of psoriatic arthritis in Brazil were compared.

• The parameters were extracted from two real-world studies in Brazil

• - Four scenarios were performed considering the main involvement (peripheral or axial) and costs category (total or only biological drugs)

• Etanercept was the most cost-effective drug in all scenarios

• - The difference in utility was minimal

• The costs were the main factor that impacted the cost-utility ratio

• Price renegotiation is very important for the choice of the most cost-effective drug and allows the efficient allocation of resources in the health system.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewers Disclosure

One reviewer declares receiving research, speaking and/or consulting support from a variety of companies including Galderma, GSK/Stiefel, Almirall, Alvotech, Leo Pharma, BMS, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Ortho Dermatology, Abbvie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Helsinn, Arena, Forte, Informa, UpToDate and National Psoriasis Foundation. They also consult for others through Guidepoint Global, Gerson Lehrman and other consulting organizations; are a founder and majority owner of www.DrScore.com, and are a founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

The authors declare funding from Ministério da Ciência, Tecnologia e Inovação Conselho Nacional de Desenvolvimento Científico e Tecnológico 471819/2013-1, and Fundação de Amparo à Pesquisa do Estado de Minas Gerais 0515-15 03799-16.