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Vol. 17. Issue 9.
Pages 536-542 (November 2021)
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Vol. 17. Issue 9.
Pages 536-542 (November 2021)
Original Article
A cost-consequence analysis of the preferential use of secukinumab versus adalimumab for the treatment of psoriatic arthritis
Análisis de las consecuencias en materia de costos del uso preferencial del secukinumab en comparación con el adalimumab para el tratamiento de la artritis psoriásica
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Alberto Jiménez-Moralesa, Rafael Cáliza, Susana Aceitunob, Miriam Pradesb, Carles Blanchc,
Corresponding author
carles.blanch@novartis.com

Corresponding author.
a Virgen de las Nieves University Hospital, Granada, Spain
b Outcomes’10, Castellón de la Plana, Spain
c Novartis Pharmaceuticals, Novartis Farmacéutica, Barcelona, Spain
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Tables (5)
Table 1. Clinical efficacy data (at 24 weeks) used in the analysis: matching-adjusted indirect comparisons of secukinumab and adalimumab.
Table 2. Dosage and unit cost of the treatments included in the analysis.13,14
Table 3. Cost of treatment for each treatment sequence considered in the analysis according to dosage.
Table 4. Cost of treatment for each hypothetical cohort of 10 patients considering the clinical response (ACR) extracted from Nash P. et al.10
Table 5. Cost of treatment for each hypothetical cohort of 10 patients considering the clinical response (ACR) extracted from Strand V. et al.11
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Additional material (1)
Abstract
Objectives

To assess the efficiency of secukinumab compared to adalimumab as first biologic treatment for psoriatic arthritis (PsA) from the Spanish National Health System (SNHS) perspective.

Methods

A cost-consequence analysis of the cost and clinical response of two treatment strategies was conducted over a 2-year time horizon. A hypothetical cohort of 10 patients with PsA initiated treatment with secukinumab 150mg (cohort A) or adalimumab 40mg (cohort B), respectively. Patients achieving clinical response (ACR20/50/70) at week 24 continued the initial treatment, while patients with inadequate response switched to secukinumab 300mg. Pharmacological costs were calculated based on SmPC (notified ex-factory price). The lowest cost of adalimumab biosimilar was considered. Data on clinical response were extracted from the two matching-adjusted indirect comparison (MAIC) published comparing secukinumab vs adalimumab. Results were expressed as the cost difference between the two cohorts (€, 2019) and were calculated for each clinical response criteria (ACR20/50/70) and for each MAIC. Sensitivity analysis assessed the impact of potential discounts on the cost of adalimumab while maintaining the cost of secukinumab unchanged.

Results

Depending on the MAIC used, the cost of initiating biologic treatment for PsA with secukinumab 150mg was 18–33% lower than the one estimated for adalimumab 40mg, for ACR20, 18–28% for ACR50, and 16–23% for ACR70 response rate. Sensitivity analysis showed that it would be necessary a discount of 40–60%, 40–65% and 50–75% over the adalimumab cost to compensate for the differences in efficacy observed for ACR20/50/70, respectively, depending on the MAIC used.

Conclusion

In patients with PsA, secukinumab could be considered a more efficient first-line biologic treatment compared to adalimumab, from the SNHS perspective.

Keywords:
Psoriatic arthritis
Secukinumab
Adalimumab
Biosimilars
Indirect comparison
Cost
Resumen
Objetivos

Evaluar la eficiencia de secukinumab comparado con adalimumab como primer tratamiento biológico para la artritis psoriásica desde la perspectiva del Sistema Nacional de Salud español.

Métodos

Se realizó un análisis de coste-consecuencia considerando el coste y la respuesta clínica a dos estrategias de tratamiento, en un horizonte temporal de 2 años. Una cohorte hipotética de 10 pacientes con artritis psoriásica inició el tratamiento con secukinumab 150mg (cohorte A) o adalimumab 40mg (cohorte B), respectivamente. Los pacientes con respuesta clínica (ACR20/50/70) en la semana 24 continuaron el tratamiento inicial, mientras que los pacientes con respuesta inadecuada recibieron 300mg de secukinumab. Los costes farmacológicos se calcularon en base a la ficha técnica (precio notificado). Se consideró el coste más bajo de adalimumab biosimilar. Los datos de respuesta clínica se extrajeron de los dos estudios publicados de comparación indirecta ajustada entre secukinumab y adalimumab. Se calculó la diferencia de coste entre las dos cohortes (€, 2019) para cada criterio de respuesta (ACR20/50/70) y para cada estudio. El análisis de sensibilidad evaluó los resultados aplicando posibles descuentos sobre el coste de adalimumab, manteniendo constante el coste de secukinumab.

Resultados

Dependiendo del estudio utilizado, el coste de iniciar el tratamiento biológico con secukinumab 150mg fue un 18-33% menor que el estimado para adalimumab 40mg, para ACR20, 18-28% para ACR50, y 16-23% para ACR70. El análisis de sensibilidad mostró que sería necesario un descuento del 40-60%, 40-65% y 50-75% sobre el coste del adalimumab para compensar las diferencias de eficacia observadas para ACR20/50/70, respectivamente.

Conclusión

En pacientes con artritis psoriásica, la elección de secukinumab como terapia biológica inicial podría considerarse una opción más eficiente comparado con adalimumab desde la perspectiva del Sistema Nacional de Salud español.

Palabras clave:
Artritis psoriásica
Secukinumab
Adalimumab
Biosimilares
Comparación indirecta
Coste

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