BACKGROUND: Ankylosing spondylitis (AS) is a progressive arthritic disease causing pain and severe physical impairments, negatively impacting health-related quality of life. Approximately 127,000 people are estimated to have AS in the United Kingdom (UK). The objective of this analysis was to estimate the budget impact, over a 5-year period, from the perspective of the UK National Health Service (NHS), of introducing secukinumab as an alternative to tumour-necrosis factor (TNF)-α inhibitors for the treatment of adult AS patients with inadequate response to non-steroidal anti-inflammatory drugs. Secukinumab, the first fully human anti-interleukin-17A inhibitor, is the first licensed biologic alternative to TNF-α inhibitors for AS.
METHODS: A budget impact model was developed to compare the drug acquisition and administration costs with and without the introduction of secukinumab. Biosimilar and originator TNF-α inhibitors currently available in the UK were included in the analysis. UK population projections were obtained from the Office for National Statistics and published literature. Current and future market share projections were obtained from the NHiS and internal Novartis data. The licensed posology was used for all treatments. Drug costs were sourced from the British National Formulary. English administration costs from NHS Reference Costs and Personal Social Services Research Unit were applied and assumed to be relevant for the whole of the UK. The efficacy of secukinumab was assumed to be at least equivalent to the TNF-α inhibitors, based on published indirect comparisons. Therefore, direct and indirect disease-related costs were not included in the model.
RESULTS: At list price, the cumulative budget impact of introducing secukinumab is estimated to yield savings of £5.0 million over a 2-year period, rising to £49.2 million over a 5-year period. Sensitivity analyses revealed that greater secukinumab usage further increased the expected cost savings for the UK NHS. A confidential patient access scheme, which has become available to the UK NHS, will further increase the potential savings.
CONCLUSION: Secukinumab is a clinically effective and cost-saving treatment option for AS in the UK. Within a fixed healthcare budget, the introduction of secukinumab can potentially enable more UK patients to be treated for this irreversible condition.
