Secukinumab As A More Efficient Alternative For The Treatment of Ankylosing Spondylitis: A Cost Per Responder Analysis Versus Adalimumab And Golimumab From A Colombian Perspective

Abstract

The objective of this analysis was to compare the cost per responder based on the Assessment of Spondyloarthritis International Society (ASAS) outcomes at 24 weeks of treatment of ankylosing spondylitis (AS) with secukinumab relative to adalimumab and golimumab from a third payer perspective. The cost per responder for each treatment was estimated by dividing the drug acquisition cost with its response rate. Drug costs were estimated in US dollars (USD) from public sources: SISMED 2016 Q1-Q4 for secukinumab and golimumab, and Circular 01 de 2016 for adalimumab (due to its maximum price regulation), using the number of doses required for 24 weeks of treatment. Response rates were used from a previous matching-adjusted indirect comparison (MAIC) based on the data from MEASURE1-2, ATLAS and GO-RAISE clinical trials of secukinumab, adalimumab and golimumab, respectively. MAIC analysis matched several patient characteristic such as age, gender distribution, Bath Ankylosing Spondylitis Functional Index (BASFI), C-reactive protein (CRP) and TNF-naive proportion at the baseline. MAIC analysis showed higher ASAS20, ASAS40 and ASAS5/6 response rates for secukinumab compared to adalimumab and golimumab. The cost per ASAS20 responder were USD6.733 vs USD9.988, cost per ASAS40 responder were USD8.028 vs USD12.790, whereas, costs per ASAS5/6 responder were USD15.665 vs USD22.800 for secukinumab vs adalimumab, respectively. The cost per ASAS20 responder were USD6.549 vs USD8.713, cost per ASAS40 responder were USD7.889 vs USD11.036, whereas, costs per ASAS5/6 responder were USD14.365 vs USD18.919 for secukinumab vs golimumab, respectively. Sensitivity analyses for ASAS response rates and cost per responder, showed similar results, validating the main analysis. Cost per responder for ASAS outcomes were consistently lower for secukinumab versus all comparators, showing the dominance of secukinumab versus adalimumab and golimumab. These findings indicate that it is more efficient to treat AS patients with secukinumab in the Colombian context.