Cost Effectiveness of Secukinumab Versus Other Biologics and Apremilast in the Treatment of Active Psoriatic Arthritis in Germany

Introduction Psoriatic arthritis (PsA) is a chronic inflammatory arthritis that occurs in people affected by the autoimmune disease psoriasis. The cost effectiveness of secukinumab in PsA has not been evaluated in Germany. Objective The purpose of this study was to conduct a cost-utility analysis of secukinumab in three adult populations with active PsA in Germany: biologic naïve without moderate or severe plaque psoriasis, biologic naïve with moderate or severe plaque psoriasis, and biologic experienced. Comparators included other disease-modifying antirheumatic drugs (DMARDs), including biosimilar versions as well as standard of care. Methods The analysis took the viewpoint of the German statutory health insurance. We adapted a decision analytic semi-Markov model to evaluate the cost effectiveness of secukinumab over a lifetime horizon. Treatment response was assessed based on PsA Response Criteria at 12 weeks. Nonresponders or patients discontinuing the initial-line DMARD were allowed to switch to subsequent-line DMARDs. Model input parameters (Psoriasis Area Severity Index, Health Assessment Questionnaire (HAQ), withdrawal rates, costs, and resource use) were collected from clinical trials, published literature, and official reports. Health benefits were expressed as quality-adjusted life-years. An annual discount rate of 3% was applied to costs and benefits. The robustness of the study findings was evaluated via sensitivity analyses. Results In the biologic-naïve population without moderate or severe plaque psoriasis, secukinumab 150 mg either strictly dominated other DMARDs (certolizumab pegol, golimumab, and ustekinumab) or yielded favorable incremental cost-effectiveness ratios (ICERs) (vs. etanercept, adalimumab, and infliximab). In the biologic-naïve population with concomitant moderate to severe plaque psoriasis and in the biologic-experienced population, secukinumab 300 mg was more effective and had a lower ICER than other DMARDs, thus leading to extended dominance. Deterministic sensitivity analyses indicated that the results were most sensitive to the discount rate for costs and health outcomes as well as the HAQ score as an input to utility values. Conclusions Secukinumab appears to be cost effective compared with other DMARDs for the treatment of active PsA in biologic-naïve and biologic-experienced populations in Germany.