Mørup Michael F, Taieb Vanessa, Willems Damon, Rose Micah, Lyris Nikos, Lamotte Mark, Gerlier Laetitia, Thom Howard
UCB Pharma, Copenhagen, Denmark.
UCB Pharma, Colombes, France.
J Med Econ. 2024 Jan-Dec;27(1):682-696. doi: 10.1080/13696998.2024.2342209. Epub 2024 May 2.
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.
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.
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.
Results were based on list prices. Data concerning up-titration to secukinumab 300 mg was scarce.
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.
从苏格兰国民保健服务体系（NHS Scotland）的角度，评估与白细胞介素17A抑制剂（IL-17Ai's）司库奇尤单抗和依奇珠单抗相比，在中轴型脊柱关节炎（axSpA）患者中起始使用比美吉珠单抗（一种选择性抑制白细胞介素（IL）-17F和IL-17A的单克隆IgG1抗体）的治疗路径的成本效益。
使用决策树模型，随后是终生马尔可夫模型对axSpA治疗路径进行建模。该路径包括一线和二线生物改善病情抗风湿药物（bDMARD），随后是最佳支持治疗（bDMARD，非生物制剂）。将比美吉珠单抗序贯任何bDMARD（“BKZ”）与IL-17Ai's进行比较：150mg司库奇尤单抗序贯剂量递增至300mg司库奇尤单抗及任何bDMARD的联合治疗（“SEC”），或依奇珠单抗序贯任何bDMARD（“IXE”）。向下一治疗的转换由巴斯强直性脊柱炎疾病活动指数-50%（BASDAI50）无反应或任何原因停药触发。一项已发表的网状荟萃分析提供了疗效数据。通过将强直性脊柱炎疾病活动评分进行映射得出欧洲五维健康量表效用值。成本包括疾病管理（与功能受限相关）、生物制剂采购（标价）、给药和监测（NHS 2021/22）。贴现率为每年3.5%。对非放射学axSpA和强直性脊柱炎患者的概率结果进行平均，以反映axSpA疾病谱。进行了情景分析和敏感性分析。
BKZ的增量成本效益比（ICER）为24,801英镑/质量调整生命年（QALY），而SEC为（95%可信区间24,163-25,895英镑）。BKZ与IXE的成本相似（差异-385英镑[-15,239-14,468英镑]），QALY也相似（差异0.039[-0.748-0.825]），净货币效益为1,523英镑（862-2,222英镑）。在大多数情景下结论不变。结果的驱动因素包括BASDAI50反应率和疾病管理成本。
结果基于标价。关于司库奇尤单抗剂量递增至300mg的数据稀缺。
在苏格兰，比美吉珠单抗治疗路径代表了整个axSpA疾病谱的一种具有成本效益的选择。与包括剂量递增的司库奇尤单抗治疗路径相比，比美吉珠单抗具有成本效益，并且与依奇珠单抗治疗路径具有相似的成本和QALY。
