Abstract
Biosimilar infliximab (Inflectra®) has been approved by the European Medicines Agency for the treatment of active and progressive psoriatic arthritis (PsA) in adult patients since 2013. Currently in most European countries, the price of biosimilars is considerably lower compared to the reference product. We aim to compare cost-effectiveness of adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, secukinumab, ustekinumab and biosimilar infliximab for the treatment of PsA in nine European countries: Belgium, France, Germany, Hungary, Italy, the Netherlands, Spain, Sweden and the UK. The analysis was based on a probabilistic Markov model of selected biological treatment sequences compared to the standard care or to other biological sequences in patients with PsA with inadequate response to previous disease-modifying antirheumatic drug therapy. Transition probabilities between health states were derived from randomized controlled trials. The model included costs of drugs, monitoring, administration and hospitalisation from third-party payer perspective. A five-year time horizon was adopted, and both costs and benefits were discounted at country-specific discount rates. The incremental cost-utility ratios (ICUR) of biosimilar infliximab-standard care treatment sequence versus standard care were as follows: €50,103/QALY (Belgium), €60,141/QALY (France), €79,730/QALY (Germany), €40,897/QALY (Hungary), €48,059/QALY (Italy), €49,212/QALY (the Netherlands), €53,602/QALY (Spain), €74,773/QALY (Sweden) and €68,697/QALY (the UK). Compared to standard care, the originator infliximab was dominated by biosimilar infliximab in all countries. The inclusion of additional biologicals to the treatment sequence resulted in higher cost-utility ratios. ICURs of biosimilar infliximab-secukinumab-etanercept sequence ranged from €54,946/QALY to €104,113/QALY and between €67,487/QALY and €121,203/QALY for the biosimilar infliximab-ustekinumab-certolizumab pegol sequence. The results were the most sensitive to changes in the perspective of the analysis, utility weights and time horizon (10-year). Biosimilar infliximab is a cost-effective alternative to the originator product for the treatment of adults with PsA that may increase the affordability of, and thus the access to biological treatments in Europe.
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