Efficacy-Based Budget Impact Analysis of Secukinumab Vs Adalimumab in the Treatment of Ankylosing Spondylitis in Finland

Abstract

Biologic treatments have enhanced the treatment outcomes of patients with active ankylosing spondylitis (AS). Until recently, TNF-alpha-inhibitors have been the only biologics approved for the treatment of active AS. We assessed the potential budget impact of the first non-TNF-alpha biologic secukinumab (fully human IL-17A-inhibitor) versus adalimumab (TNF-alpha-inhibitor) in the treatment of AS in the Finnish public health care setting. The number of patients and current market share of different biologics were based on national reimbursement registry data. Patients were assumed to receive either adalimumab (40mg) or secukinumab (150mg) according to their approved dose. Among the included patients (n=827) 26% were estimated to begin their first biologic treatment, and rest were assumed to be on ongoing treatment. Response to treatment and subsequent switching was incorporated in order to take further treatment lines into account. Response rates were based on a previously published matching-adjusted indirect comparison (MAIC) between secukinumab and adalimumab. Patients not achieving response (ASAS20) were switched to another biologic treatment. All patients received full year treatment. Cost for second line biologic treatment was weighted with the corresponding market shares. According to the budget impact analysis, treating AS patients with secukinumab instead of adalimumab would lead to EUR4,8M savings within a 1-year time period. The annual total costs were EUR6,5M vs EUR11,3M with/without secukinumab, respectively. Potentially 74% more AS patients (1442 vs 827) could be treated with secukinumab instead of adalimumab under a given health care budget. The response rates for secukinumab were consistently higher compared to adalimumab, based on matching-adjusted indirect comparison. Considerably more patients could be treated more effectively with a biologic under rational allocation of resources. These results also suggest dominance of secukinumab compared to adalimumab as it gives higher treatment outcomes with lower costs in the treatment of patients with active AS in Finland.