COST-UTILITY ANALYSIS OF SECUKINUMAB USE VERSUS TNF-? INHIBITORS, IN PATIENTS WITH ANKYLOSING SPONDILYTIS

OBJECTIVES: To assess the cost-utility of secukinumab in the treatment of ankylosing spondylitis (AS) patients in Colombia versus TNF-a inhibitors METHODS: The cost-effectiveness model captures health benefits (measured by quality-adjusted life years [QALYs]) and costs associated with the use of secukinumab and TNF-a inhibitors over time horizons of 1 and 10 years in two subgroups of patients regarding the previous use of biologies: naive and experienced. A Markov model captured treatment effects on Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) using relative treatment response rates for technologies from a network meta-analysis including MEASURE2 trial for secukinumab. Patient quality of life was based on an algorithm linking BASDAI and BASFI scores, gender and age to utilities. Probabilities of shift, maintenance or discontinuation, depend on BASDAI and BASFI results. Costs include those of drugs, procedures, relevant adverse events, and are measured in Colombian Pesos from third payer perspective based in national public databases and tariffs. RESULTS: According to the base case for 1 and 10 years, secukinumab turned out to be dominant (more effective and less costly) versus certolizumab pegol, etanercept and adalimumab for both patient subgroups. Long-term incremental QALYs for biologic naive patients with secukinumab versus certolizumab pegol, etanercept and adalimumab were 0.099, 0.164 and 0.046, respectively and incremental cost were -$28,472,133, -$27,696,705 and -$39,077,037, respectively. Versus infliximab and golimumab, secukinumab is less costly, but minimally less effective than these alternative treatments, for both subgroups of patients and both time horizons. CONCLUSIONS: The use of secukinumab turns out to be a therapy with better results in terms of quality of life and lower treatment costs for ankylosing spondylitis patients versus most currently used TNF-a inhibitors in Colombia, thus it is recommended to be reimbursed by the Colombian healthcare system.