Cost-effectiveness analysis of ixekizumab versus secukinumab in patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis in Spain
Objective To conduct a cost-effectiveness analysis from the perspective of the Spanish National Health System (NHS) comparing ixekizumab versus secukinumab.Design A Markov model with a lifetime horizon and monthly cycles was developed based on the York model. Four health states were included: a biol...
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BMJ Publishing Group
2020-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/8/e032552.full |
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| author | Susanne Hartz Christophe Sapin Bernd Schweikert Chiara Malmberg Mercedes Núñez Tatiana Dilla |
| author_facet | Susanne Hartz Christophe Sapin Bernd Schweikert Chiara Malmberg Mercedes Núñez Tatiana Dilla |
| author_sort | Susanne Hartz |
| collection | DOAJ |
| description | Objective To conduct a cost-effectiveness analysis from the perspective of the Spanish National Health System (NHS) comparing ixekizumab versus secukinumab.Design A Markov model with a lifetime horizon and monthly cycles was developed based on the York model. Four health states were included: a biological disease-modifying antirheumatic drug (bDMARD) induction period of 12 or 16 weeks, maintenance therapy, best supportive care (BSC) and death. Treatment response was assessed based on both Psoriatic Arthritis Response Criteria (PsARC) and ≥90% improvement in the Psoriasis Area Severity Index score (PASI90). At the end of the induction period, responders transitioned to maintenance therapy. Non-responders and patients who discontinued maintenance therapy transitioned to BSC. Clinical efficacy data were derived from a network meta-analysis. Health utilities were generated by applying a regression analysis to Psoriasis Area Severity Index and Health Assessment Questionnaire‒Disability Index scores collected in the ixekizumab SPIRIT studies. Results were subject to extensive sensitivity and scenario analysis.Setting Spanish NHS.Participants A hypothetical cohort of bDMARD-naïve patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis was modelled.Interventions Ixekizumab and secukinumab.Results Ixekizumab performed favourably over secukinumab in the base-case analysis, although cost savings and quality-adjusted life-year (QALY) gains were modest. Total costs were €153 901 compared with €156 559 for secukinumab (difference −€2658). Total QALYs were 9.175 vs 9.082 (difference 0.093). Base-case results were most sensitive to the annual bDMARD discontinuation rate and the modification of PsARC and PASI90 response to ixekizumab or secukinumab.Conclusion Ixekizumab provided more QALYs at a lower cost than secukinumab, with differences being on a relatively small scale. Sensitivity analysis showed that base-case results were generally robust to changes in most input parameters.Trial registration number SPIRIT-P1: NCT01695239; Post-results, SPIRIT-P2: NCT02349295; Post-results. |
| format | Article |
| id | doaj-art-6ebbbc3e135f47f6a7147a057648c82d |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-08-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-6ebbbc3e135f47f6a7147a057648c82d2025-08-20T02:38:28ZengBMJ Publishing GroupBMJ Open2044-60552020-08-0110810.1136/bmjopen-2019-032552Cost-effectiveness analysis of ixekizumab versus secukinumab in patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis in SpainSusanne Hartz0Christophe Sapin1Bernd Schweikert2Chiara Malmberg3Mercedes Núñez4Tatiana Dilla5Global Patient Outcomes and Real World Evidence International, Eli Lilly and Company, Windlesham, UKEli Lilly and Company, Indianapolis, Indiana, USAReal World Evidence Strategy and Analytics, Commercialisation and Outcomes, ICON, Munich, GermanyAccess, Commercialisation and Communications, ICON, Munich, GermanyHealth Outcomes and Real World Evidence, Eli Lilly and Company, Madrid, SpainGlobal Patient Outcomes and Real World Evidence International, Eli Lilly and Company, Madrid, SpainObjective To conduct a cost-effectiveness analysis from the perspective of the Spanish National Health System (NHS) comparing ixekizumab versus secukinumab.Design A Markov model with a lifetime horizon and monthly cycles was developed based on the York model. Four health states were included: a biological disease-modifying antirheumatic drug (bDMARD) induction period of 12 or 16 weeks, maintenance therapy, best supportive care (BSC) and death. Treatment response was assessed based on both Psoriatic Arthritis Response Criteria (PsARC) and ≥90% improvement in the Psoriasis Area Severity Index score (PASI90). At the end of the induction period, responders transitioned to maintenance therapy. Non-responders and patients who discontinued maintenance therapy transitioned to BSC. Clinical efficacy data were derived from a network meta-analysis. Health utilities were generated by applying a regression analysis to Psoriasis Area Severity Index and Health Assessment Questionnaire‒Disability Index scores collected in the ixekizumab SPIRIT studies. Results were subject to extensive sensitivity and scenario analysis.Setting Spanish NHS.Participants A hypothetical cohort of bDMARD-naïve patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis was modelled.Interventions Ixekizumab and secukinumab.Results Ixekizumab performed favourably over secukinumab in the base-case analysis, although cost savings and quality-adjusted life-year (QALY) gains were modest. Total costs were €153 901 compared with €156 559 for secukinumab (difference −€2658). Total QALYs were 9.175 vs 9.082 (difference 0.093). Base-case results were most sensitive to the annual bDMARD discontinuation rate and the modification of PsARC and PASI90 response to ixekizumab or secukinumab.Conclusion Ixekizumab provided more QALYs at a lower cost than secukinumab, with differences being on a relatively small scale. Sensitivity analysis showed that base-case results were generally robust to changes in most input parameters.Trial registration number SPIRIT-P1: NCT01695239; Post-results, SPIRIT-P2: NCT02349295; Post-results.https://bmjopen.bmj.com/content/10/8/e032552.full |
| spellingShingle | Susanne Hartz Christophe Sapin Bernd Schweikert Chiara Malmberg Mercedes Núñez Tatiana Dilla Cost-effectiveness analysis of ixekizumab versus secukinumab in patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis in Spain BMJ Open |
| title | Cost-effectiveness analysis of ixekizumab versus secukinumab in patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis in Spain |
| title_full | Cost-effectiveness analysis of ixekizumab versus secukinumab in patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis in Spain |
| title_fullStr | Cost-effectiveness analysis of ixekizumab versus secukinumab in patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis in Spain |
| title_full_unstemmed | Cost-effectiveness analysis of ixekizumab versus secukinumab in patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis in Spain |
| title_short | Cost-effectiveness analysis of ixekizumab versus secukinumab in patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis in Spain |
| title_sort | cost effectiveness analysis of ixekizumab versus secukinumab in patients with psoriatic arthritis and concomitant moderate to severe psoriasis in spain |
| url | https://bmjopen.bmj.com/content/10/8/e032552.full |
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