Abstract
To conduct a cost-effectiveness analysis (CEA) of secukinumab versus ustekinumab for the treatment of psoriatic arthritis (PsA) from a third party payer’s perspective in the United States (US). A Markov model with 10 year time horizon with six months cycle duration was developed. Model assumptions included: cohort mean age of 47.3 years (data extracted from recent systematic review). Relative risks of mortality for individuals with PsA (male: 1.65; female: 1.59) as well as background mortality by age and gender were obtained from published studies and US vital statistics report. Costs included were: medications (wholesale acquisition cost), adverse events (i.e.- malignancy and infections; based on Medical Expenditure Panel Survey) and laboratory test and imaging (based on Medicare Fee Schedule). Medication costs were calculated to include loading and maintenance doses. The reported clinical trial changes in Health Assessment Questionnaire Disability Index (HAQDI) scores from baseline to six months were used to calculate utilities based on a linear regression equation from literature (EQ-5D = 0.809 -0.267*HAQDIchange). All costs were expressed in terms of 2018 US dollars and an annual 3% discount rate was used. Sensitivity analyses were conducted to determine the robustness of the results. In the base case scenario, secukinumab treated patients had 7.1785 QALYs and a cost of $491,329. For ustekinumab, the QALYs was 7.1778 QALY and cost of $453,821. The incremental cost-effectiveness ratio (ICER) of using secukinumab was $53 million per QALY gained, due to the very small difference in QALYs (0.0007). The model was sensitive to utility assumptions as well as patient cohort demographics (age and gender) but not sensitive to medication prices. Secukinumab and ustekinumab are nearly equivalent in terms of QALYs but the difference in cost results in a very high ICER value for secukinumab as compared to ustekinumab.
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