open access publication

Article, 2024

The cost-effectiveness of a bimekizumab versus IL-17A inhibitors treatment-pathway in patients with active axial spondyloarthritis in Scotland

Journal of Medical Economics, ISSN 1941-837X, 1369-6998, Volume 27, 1, Pages 682-696, 10.1080/13696998.2024.2342209

Contributors

Mørup, Michael Frank 0000-0002-1987-1223 [1] Taieb, Vanessa 0000-0003-0655-8630 [2] Willems, Damon 0000-0001-8263-4047 [3] Rose, Micah [4] Lyris, Nikos [4] Lamotte, Mark [5] Gerlier, Laetitia C 0000-0003-0061-0194 (Corresponding author) [6] Thom, Howard H Z 0000-0001-8576-5552 [7] [8]

Affiliations

  1. [1] UCB Pharma, Copenhagen, Denmark
    2. [NORA names: Miscellaneous; Denmark; Europe, EU; Nordic; OECD];
  2. [2] UCB Pharma (France)
    3. [NORA names: France; Europe, EU; OECD];
  3. [3] UCB Pharma (Belgium)
    4. [NORA names: Belgium; Europe, EU; OECD];
  4. [4] UCB Pharma (United Kingdom)
    5. [NORA names: United Kingdom; Europe, Non-EU; OECD];
  5. [5] Th(is), 2, Modeling, Asse, Belgium
    6. [NORA names: Belgium; Europe, EU; OECD];

Abstract

OBJECTIVE: To estimate the cost-effectiveness of a treatment-pathway initiated with bimekizumab, a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F and IL-17A, in patients with axial spondyloarthritis (axSpA) compared with IL-17Ai's, ixekizumab, and secukinumab, from the NHS Scotland perspective. METHODS: The axSpA treatment-pathway was modeled using a decision tree followed by a lifetime Markov model. The pathway included first- and second-line biologic disease-modifying antirheumatic drugs (bDMARD), followed by best supportive care (bDMARD, nonbiologic). Bimekizumab followed by any bDMARD ("BKZ") was compared with IL-17Ai's: secukinumab 150 mg followed by a blend ("SEC") of dose up-titration to secukinumab 300 mg and any bDMARD, or ixekizumab followed by any bDMARD ("IXE"). Transition to the next therapy was triggered by Bath Ankylosing Spondylitis Disease Activity Index-50% (BASDAI50) non-response or any-cause discontinuation. A published network meta-analysis provided efficacy data. EuroQoL-5-dimensions utilities were derived by mapping from Ankylosing Spondylitis Disease Activity Score. Costs included disease management (linked to functional limitations), biologics acquisition (list prices), administration and monitoring (NHS 2021/22). Discounting was 3.5%/year. Probabilistic results from patients with non-radiographic axSpA and ankylosing spondylitis were averaged to reflect the axSpA disease spectrum. Scenario and sensitivity analyses were performed. RESULTS: The incremental cost-effectiveness ratio (ICER) of BKZ was £24,801/quality-adjusted life-year (QALY) vs. SEC (95% credible interval £24,163-£25,895). BKZ had similar costs (Δ -£385 [-£15,239-£14,468]) and QALYs (Δ 0.039 [-0.748-0.825]) to IXE, with £1,523 (£862-£2,222) net monetary benefit. Conclusions remained unchanged in most scenarios. Results' drivers included BASDAI50 response rate and disease management cost. LIMITATIONS: Results were based on list prices. Data concerning up-titration to secukinumab 300 mg was scarce. CONCLUSIONS: The bimekizumab treatment-pathway represents a cost-effective option across the axSpA disease spectrum in Scotland. Bimekizumab is cost-effective compared to a secukinumab-pathway that includes dose up-titration, and has similar costs and QALYs to an ixekizumab-pathway.

Keywords

Ankylosing Spondylitis Disease Activity Score, BASDAI50, BKZ, Disease Activity Score, EuroQol 5-Dimensions utility, EuroQol-5 Dimensions, IL-17A, IXE, IgG1 antibodies, Markov model, NHS, QALY, Results Drivers, Scotland, acquisition, active axial spondyloarthritis, activity score, administration, analysis, ankylosing spondylitis, antibodies, antirheumatic drugs, axSpA, axial spondyloarthritis, bath, benefits, bimekizumab, biologic disease-modifying antirheumatic drugs, biological acquisitions, biology, blends, care, cost, cost-effective, cost-effective option, cost-effectiveness ratio, data, decision, decision tree, discontinuation, disease, disease management, disease management costs, disease spectrum, disease-modifying antirheumatic drugs, dose, dose up-titration, drivers, drug, efficacy, efficacy data, incremental cost-effectiveness ratio, inhibits interleukin (IL)-17F, interleukin (IL)-17F, ixekizumab, lifetime, lifetime Markov model, management, management costs, maps, meta-analysis, model, monetary benefits, monitoring, monoclonal IgG1 antibody, network meta-analysis, next therapy, non-radiographic axSpA, non-response, options, pathway, patients, perspective, price, probabilistic results, published network meta-analysis, rate, ratio, response rate, results, scenarios, scores, second-line biological disease-modifying antirheumatic drug, secukinumab, sensitivity, sensitivity analysis, spectra, spondylitis, spondyloarthritis, supportive care, therapy, transition, treatment pathways, trees, up-titration, utilization

Funders

  • UCB Pharma (Belgium)

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