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Bimekizumab was found to be more cost-effective than most biologics and targeted synthetic disease-modifying antirheumatic drugs in a Swedish healthcare system-based model.
Bimekizumab is cost-effective against most available treatments for psoriatic arthritis (PsA) in Sweden, based on simulations from a Markov model for the lifelong clinical pathway of patients with PsA.
Results of the analysis called attention to the economic value of bimekizumab, which achieved greater quality-adjusted life years (QALY) in patients with PsA than most biologics and targeted synthetic disease-modifying antirheumatic drugs regardless of prior tumor necrosis factor (TNF) inhibitor exposure.1
“The treatment landscape for PsA continues to evolve, and this constitutes a therapeutic advance in the clinical care of patients,” wrote investigators.1 “However, it also represents a challenge to clinical decision-making due to the need for evidence regarding the comparative effectiveness of these treatments and, in some cases, their economic implications.”
There is no cure for PsA, but several treatments are available to help affected patients manage their symptoms, including a combination of medication and non-drug therapies tailored to individual symptoms and disease severity. Lifestyle changes, physical therapy, and exercise may help slow disease progression and alleviate symptoms. Medications including nonsteroidal anti-inflammatory drugs, biologics, disease-modifying antirheumatic drugs, and corticosteroids are often necessary to manage flares.2,3 Given the chronic nature of PsA, identifying cost-effective treatments is an important step toward helping patients better handle their lifelong condition.
To assess the cost-effectiveness of bimekizumab against biologic and targeted synthetic disease-modifying antirheumatic drugs for PsA, Valgerdur Sigurdardottir, MD, of the department of rheumatology at Falun Hospital and center for clinical research at Uppsala University in Sweden, and colleagues developed a state-transition cohort model to estimate and compare the expected lifetime costs and health benefits of each treatment. Adults with symptomatic PsA with or without concomitant psoriasis who had not responded adequately to prior treatment with conventional synthetic disease-modifying antirheumatic drugs were included in the model and divided into 2 subpopulations based on previous exposure to biologic treatments: disease-modifying antirheumatic drugs-naïve and TNF inhibitor-experienced.1
Costs were estimated in Swedish krona (SEK) and converted to Euros (€). A willingness-to-pay threshold of 500,000 SEK, or €50,000, per incremental QALY was applied to determine cost-effectiveness, with any comparison yielding an incremental cost-effectiveness ratio of less than 500,000 SEK considered cost-effective and greater than 500,000 SEK considered not cost-effective. Cost of medications, management, and drug administration were considered in the base-case analyses.1
The effect of treatment was incorporated in the model as improvement in joint or skin symptoms and physical function. Response was assessed at the end of induction against the American College of Rheumatology 50% and Psoriasis Area and Severity Index 75% response criteria based on relative effect estimates obtained from a prior literature review.1
Upon analysis, infliximab treatment provided the greatest lifetime QALYs (14.22) followed by bimekizumab (14.08) in patients naive to biologic disease-modifying antirheumatic drugs. Bimekizumab was more effective and produced lower costs against guselkumab Q4W and Q8W, secukinumab 300 mg, ixekizumab, and ustekinumab 45 mg and 90 mg. It was also more effective and incurred fewer than €50,000 additional costs for each additional QALY compared to risankizumab, tofacitinib, upadacitinib, and TNF inhibitors, except adalimumab biosimilar.1
For TNF inhibitor-experienced patients, certolizumab pegol provided the greatest lifetime QALYs (13.84) followed by bimekizumab (13.56). Bimekizumab was more effective and produced lower costs then ixekizumab and secukinumab 300 mg while being cost-effective against all other comparators. Investigators pointed out drug costs varied across compared treatments, but the majority of the costs in the model were associated with disease management and varied less between treatments.1
“This study fills an important gap in the literature regarding the economic value of biological and targeted synthetic treatments for PsA in Sweden,” concluded investigators.1