Secukinumab Vs Adalimumab for the Treatment of Psoriasic Arthritis: a Cost Per Responder Analysis at 48 Weeks from a Peruvian Perspective for Public and Private Health Schemes

Abstract

The objective of this analysis was to compare the cost per responder based on the American College of Rheumatology (ACR) outcomes following 48 weeks of psoriatic arthritis (PsA) treatment with secukinumab (anti-IL-17 antibody) relative to adalimumab (anti-TNF antibody) 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: SEACE and DIGEMID for public and private health schemes, respectively. Response rates were estimated from a previous matching-adjusted indirect comparison (MAIC) based on the data from FUTURE2 and ADEPT clinical trials of secukinumab and adalimumab, respectively. MAIC analysis matched age, weight, race and gender distribution, PASI score, HAQ-DI score, and proportions of patients using methotrexate, with psoriasis ≥3% BSA, presence of dactylitis, enthesitis, and TNF-naive at baseline. ACR response rates were higher for secukinumab (150mg and 300mg) compared to adalimumab at 48 weeks in biologic-naive patients. Public scheme costs per ACR20 responder were USD14.088, USD30.509 and USD29.702, costs per ACR50 responder were USD19.632, USD36.527 and USD38.252, and costs per ACR70 responder were USD34.663, USD52.296 and USD56.103 for secukinumab 150mg, 300mg and adalimumab respectively. Private scheme costs per ACR20 responder were USD17.570, USD38.050 and USD58.302, costs per ACR50 responder were USD24.484, USD45.555 and USD75.085, and costs per ACR70 responder were USD43.231, USD65.221 and USD110.125 for secukinumab 150mg, 300mg and adalimumab respectively. Sensitivity analyses for ACR response and cost per responder showed similar results, confirming the validity of the main analysis. ACR response rates were higher for secukinumab compared to adalimumab. Cost per responder for ACR outcomes at 48 weeks were lower for secukinumab (150mg and 300mg) versus adalimumab, indicating that it is more efficient to treat PsA patients with secukinumab versus adalimumab in the Peruvian context.