Purmonen Timo, Törmälehto Soili, Wahlman Hanna, Puolakka Kari
a Novartis Finland Oy , Espoo , Finland.
b Pharmacoeconomics and Outcomes Research Unit , School of Pharmacy, University of Eastern Finland , Kuopio , Finland.
J Med Econ. 2019 Feb;22(2):151-157. doi: 10.1080/13696998.2018.1551227. Epub 2018 Dec 4.
Biologic treatments have enhanced the treatment outcomes of patients with active ankylosing spondylitis (AS). Until recently, TNF-alpha-inhibitors have been the only biologics approved for the treatment of active AS. The objective of this study was to assess the potential financial impact of the first non-TNF-alpha biologic secukinumab (fully human IL-17A-inhibitor) vs adalimumab (TNF-alpha-inhibitor) in the treatment of AS in Finland.
In this model-based budget impact analysis, patients were treated either with secukinumab (150 mg) or adalimumab (40 mg). The number of patients and market share of different biologics were based on national reimbursement registry data. Adalimumab was the most commonly used biologic treatment for AS, and in the base case analysis all adalimumab patients are assumed to switch to secukinumab. Response rates were based on a matching-adjusted indirect comparison between secukinumab and adalimumab. Patients not achieving response were switched to another biologic treatment.
Treating AS patients with secukinumab instead of adalimumab leads to potential savings of 18.2 million euros within a 5-year time period. The total costs within the follow-up time were 59.5 million euros and 77.7 million euros with and without secukinumab, respectively. According to sensitivity analyses, a higher adoption rate of secukinumab corresponds to higher potential savings.
Secukinumab is a cost-saving treatment option compared with adalimumab in the treatment of AS in Finland. More patients could be treated with a biologic by allocating resources more efficiently.
生物治疗改善了活动性强直性脊柱炎（AS）患者的治疗效果。直到最近，肿瘤坏死因子-α（TNF-α）抑制剂一直是唯一被批准用于治疗活动性AS的生物制剂。本研究的目的是评估在芬兰，首个非TNF-α生物制剂司库奇尤单抗（全人源白细胞介素-17A抑制剂）与阿达木单抗（TNF-α抑制剂）治疗AS的潜在财务影响。
在这项基于模型的预算影响分析中，患者分别接受司库奇尤单抗（150mg）或阿达木单抗（40mg）治疗。不同生物制剂的患者数量和市场份额基于国家报销登记数据。阿达木单抗是AS最常用的生物治疗药物，在基础病例分析中，假设所有阿达木单抗患者都改用司库奇尤单抗。缓解率基于司库奇尤单抗和阿达木单抗之间的匹配调整间接比较。未达到缓解的患者改用另一种生物治疗药物。
用司库奇尤单抗而非阿达木单抗治疗AS患者，在5年内可节省1820万欧元。随访期间，使用和不使用司库奇尤单抗的总成本分别为5950万欧元和7770万欧元。敏感性分析表明，司库奇尤单抗采用率越高，潜在节省费用越高。
在芬兰，治疗AS时，与阿达木单抗相比，司库奇尤单抗是一种节省成本的治疗选择。通过更有效地分配资源，可以用生物制剂治疗更多患者。
