OBJECTIVE: To determine the cost-effectiveness of secukinumab, a fully human IL-17A inhibitor, for adult patients in the UK with active ankylosing spondylitis (AS) who have not responded adequately to previous treatment with conventional care (CC) (biologic-naïve population) or previous biologic therapy (biologic-experienced population).
METHODS: The model was structured as a three-month decision tree leading into a Markov model. Comparators were licensed anti-TNF therapies (including biosimilar versions where available) and CC in the biologic-naïve and biologic-experienced populations, respectively. Clinical parameters captured treatment response, short-term treatment effects on disease activity and patient functioning, and long-term impact of structural disease progression. Utilities were derived from secukinumab trial data. List prices were used for all drugs.
RESULTS: In the biologic-naïve population, secukinumab dominated infliximab (biosimilar and originator) and was associated with ICERs of less than £10,000 per QALY gained versus all other comparators. In biologic-experienced patients, the ICER for secukinumab versus CC was £6,154 per QALY gained. Parameters associated with treatment response rates, short-term treatment effects, and long-term radiographic progression were amongst the key model drivers. Scenario analysis found results to be robust to changes in structural assumptions underpinning the model. Probabilistic analysis identified a higher level of uncertainty in results in the biologic-naïve population.
CONCLUSIONS: Secukinumab at list price represents a cost-effective use of NHS resources for biologic naïve and biologic experienced patients with active AS. Further research on long-term radiographic progression outcomes would be valuable in further developing cost-effectiveness analyses in this disease area.
