OBJECTIVE: To evaluate the cost-effectiveness of secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin (IL)-17A, versus currently licensed biologic therapies in patients with active psoriatic arthritis (PsA) from a Canadian healthcare system perspective.
METHODS: A decision analytic semi-Markov model evaluated the cost-effectiveness of secukinumab 150mg and 300mg compared to certolizumab pegol, etanercept, adalimumab, infliximab, infliximab biosimilar, golimumab, and ustekinumab in biologic-naïve and biologic-experienced patients, respectively, over a lifetime horizon. The response to treatments was evaluated after 12 weeks by PsA Response Criteria (PsARC) response rates. Non-responders or patients discontinuing initial-line of biologic therapy were allowed to switch to subsequent-line biologics. Model input parameters (Psoriasis Area Severity Index [PASI], Health Assessment Questionnaire [HAQ], withdrawal rates, costs, and resource use) were collected from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). Costs were reported in Canadian dollars (CAD). An annual discount rate of 5% was applied to costs and benefits.
RESULTS: In the biologic-naïve population, patients treated with secukinumab achieved the highest number of QALYs (8.54) at the lowest cost (CAD 925,387) over a lifetime horizon compared to all comparators, except for infliximab and its biosimilar, which achieved minimally more QALYs (8.58) than secukinumab. However, infliximab and its biosimilar incurred more costs than secukinumab (infliximab: CAD 1,015,437; infliximab biosimilar: CAD 941,004), resulting in worse cost-effectiveness profiles. Secukinumab dominated all therapies except infliximab, but was cost-effective versus infliximab in this population. In the biologic-experienced population, secukinumab dominated all treatments as it generated more QALYs (8.89) at lower costs (CAD 954,692). Deterministic sensitivity analyses indicated the results were most sensitive to variation in PsARC response rates, change in HAQ, and utility values.
CONCLUSIONS: Secukinumab is either dominant or cost-effective versus all licensed biologics for the treatment of active PsA in biologic-naïve and biologic-experienced populations in Canada.
