10.6084/m9.figshare.7235957.v1 Ron Goeree Ron Goeree Sima Chiva-Razavi Sima Chiva-Razavi Praveen Gunda Praveen Gunda Minal Jain Minal Jain Steffen M. Jugl Steffen M. Jugl Cost-effectiveness analysis of secukinumab in ankylosing spondylitis from the Canadian perspective Taylor & Francis Group 2018 Secukinumab ankylosing spondylitis cost-effectiveness Canada biologics;quality-adjusted life year IL-17A anti-TNF I10 I19 2018-10-22 16:58:51 Journal contribution https://tandf.figshare.com/articles/journal_contribution/Cost-effectiveness_analysis_of_secukinumab_in_ankylosing_spondylitis_from_the_Canadian_perspective/7235957 <p><b>Aim:</b> To assess the cost-effectiveness of interleukin (IL)-17A inhibitor secukinumab vs the currently licensed biologic therapies in ankylosing spondylitis (AS) patients from a Canadian healthcare system perspective.</p> <p><b>Methods:</b> A decision analytic model (semi-Markov) evaluated the cost-effectiveness of secukinumab 150 mg compared to certolizumab pegol, adalimumab, golimumab, etanercept and etanercept biosimilar, and infliximab and infliximab biosimilar in a biologic-naïve population, over 60 years of time horizon (lifetime). The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI 50) response rate was used to assess treatment response at week 12. Non-responders or patients discontinuing initial-line of biologic therapy were allowed to switch to subsequent-line biologics. Model input parameters (short-term and long-term changes in BASDAI and Bath Ankylosing Spondylitis Functional Index [BASFI], withdrawal rates, adverse events, costs, resource use, utilities, and disutilities) were obtained from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). Cost and benefits were discounted with an annual discount rate of 1.5% for all treatments.</p> <p><b>Results:</b> In the biologic-naïve population, secukinumab 150 mg dominated all comparators, as patients treated with secukinumab 150 mg achieved the highest QALYs (16.46) at the lowest cost (CAD 533,010) over a lifetime horizon vs comparators. In the deterministic sensitivity analysis, results were most sensitive to changes in baseline BASFI non-responders, BASDAI 50 at 3 months and discount rates. Probabilistic sensitivity analysis showed that secukinumab 150 mg demonstrated higher probability of achieving maximum net monetary benefit vs all comparators at various cost thresholds.</p> <p><b>Conclusions:</b> This analysis demonstrates that secukinumab 150 mg is the most cost-effective treatment option for biologic-naïve AS patients compared to certolizumab pegol, adalimumab, golimumab, etanercept and etanercept biosimilar, and infliximab and infliximab biosimilar for a lifetime horizon in Canada. Treatment with secukinumab translates into substantial benefits for patients and the healthcare system.</p>