OBJECTIVES: To determine the cost-effectiveness of secukinumab, a fully human interleukin-17A inhibitor, for adult patients in the UK with active psoriatic arthritis (PsA) who have not responded adequately to previous treatment with conventional systemic disease-modifying anti-rheumatic drugs (csDMARDs).
METHODS: A model was developed from the UK NHS perspective, structured as a three-month decision tree leading into a lifetime Markov model. Separate analyses based on number of prior csDMARDs (1 and ≥2) were conducted, with secukinumab 150 mg compared to relevant comparators for each subpopulation (Standard of Care [SoC] and tumour necrosis factor inhibitors, respectively). Response at three months and other clinical parameters were derived from the FUTURE 2 trial (1-prior csDMARD) and a network meta-analysis (≥2-prior csDMARDs). Utility values were based on FUTURE 2 trial data. List prices were used for all drugs; where available, other costs were sourced from NHS reference costs. Outcomes included total discounted costs and quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs).
RESULTS: In the 1-prior csDMARD subpopulation, the ICER for secukinumab versus SoC was £28,735 per QALY gained. In the ≥2-prior csDMARDs subpopulation, secukinumab dominated golimumab, certolizumab pegol and etanercept, and had an ICER of £5,380 per QALY gained versus adalimumab. The ICER for infliximab versus secukinumab was £1,287,449 per QALY gained (i.e. infliximab not cost-effective). The probability of secukinumab being the most cost-effective intervention at a £30,000 per QALY gained threshold was estimated to be 48.1% and 70.8% in the 1- and ≥2-prior csDMARDs subpopulations, respectively. Several scenario analyses demonstrated results to be robust.
CONCLUSIONS: Secukinumab represents a cost-effective use of NHS resources for patients with PsA who have responded inadequately to either 1- or ≥2-prior csDMARDs and in some cases dominates comparators. The availability of a confidential patient access scheme discount for secukinumab in the UK further strengthens the case for cost-effectiveness in these subpopulations
