Cost-Effectiveness Analysis of Sequential Biologic Therapy with Ixekizumab Versus Secukinumab in the Treatment of Active Psoriatic Arthritis with Concomitant Moderate-to-Severe Psoriasis in the UK

Abstract

Background Interleukin-17A (IL-17A) antagonists are a recent innovation for treating psoriatic arthritis (PsA). There are currently no cost-effectiveness analyses (CEAs) comparing the IL-17A antagonists ixekizumab and secukinumab in PsA from a UK perspective. Objective We conducted a CEA from the UK National Health Service perspective to compare ixekizumab versus secukinumab in patients with PsA and concomitant moderate-to-severe plaque psoriasis. Methods A Markov model was developed based on the widely accepted York model. In biologic disease-modifying antirheumatic drug (bDMARD)-naïve patients, ixekizumab → ustekinumab → best supportive care (BSC) was compared with secukinumab → ustekinumab → BSC. For bDMARD-experienced patients, ixekizumab → BSC was compared with secukinumab → BSC. At the end of the bDMARD trial period, Psoriatic Arthritis Response Criteria (PsARC) responders continued to receive the bDMARD in the continuous treatment period. PsARC nonresponders and patients who ceased continuous treatment transitioned to the trial period of the next treatment. Results Ixekizumab was less costly and provided more quality-adjusted life-years (QALYs) than secukinumab in bDMARDnaïve and-experienced patients based on list prices, although cost savings and QALY gains were small to modest. In bDMARD-naïve patients, total costs were £155,455 compared with £155,530 for secukinumab (year 2017 values). Total QALYs were 8.127 versus 7.989. In bDMARD-experienced patients, the corresponding values were £140,051 versus £140,264 for total costs and 3.996 versus 3.875 for total QALYs. Conclusion Ixekizumab provided more QALYs at a marginally lower cost than secukinumab, and the results were most sensitive to changes in drug costs. Other factors, such as patient preferences for the number of injections and confidential price discounts, may be important considerations in clinical decision-making.

Development and Characterization of New Monoclonal Antibodies Against Porcine Interleukin-17A and Interferon-Gamma

“…IL-17A is an ideal drug target because of its broad involvement in many host defense mechanisms by inducing proinflammatory cytokines and chemokines that participate in neutrophil and macrophage recruitment to the site of injury (17). Indeed, recent reports have shown that IL-17A plays a role in skin wound healing (18) and gut epithelial repair (19) while aIL-17A and aIFNg mAbs have been developed to treat psoriasis (20) and lymphohistiocytosis (21), respectively, in humans, with favorable outcomes. IL-17A and IFNg are therefore ideal targets for the future development of therapeutic antibodies to test using the pig biomedical model, to affirm the cytokine's involvement in many host-defense mechanisms (21)(22)(23).…”

Quantitative Evidence Synthesis Methods for the Assessment of the Effectiveness of Treatment Sequences for Clinical and Economic Decision Making: A Review and Taxonomy of Simplifying Assumptions

“…Real-world disease-specific data sources can provide essential follow-up data on entire treatment sequences, and potentially be used to emulate a pragmatic randomised trial of dynamic treatment sequences [27,[163][164][165]. If these data sources are going to be useful, treatment sequences need to be considered during the planning and development stages.…”