WHAT IS THE CADTH REIMBURSEMENT RECOMMENDATION FOR BIMZELX?: CADTH recommends that Bimzelx be reimbursed by public drug plans for the treatment of active psoriatic arthritis (PsA) if certain conditions are met. WHICH PATIENTS ARE ELIGIBLE FOR COVERAGE? Bimzelx should only be covered to treat adult patients with active PsA according to the reimbursement criteria used for other biologic disease-modifying antirheumatic drugs (bDMARDs) that are currently reimbursed by public drug plans. WHAT ARE THE CONDITIONS FOR REIMBURSEMENT? Bimzelx should only be reimbursed if it is prescribed by a rheumatologist or a clinician who has experience treating adult patients with active PsA and if it does not cost more than the least expensive bDMARD reimbursed for the treatment of active PsA. Bimzelx should not be reimbursed when used together with other biologic or targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) for active PsA. WHY DID CADTH MAKE THIS RECOMMENDATION? Evidence from 2 clinical trials demonstrated that Bimzelx improves PsA symptoms compared to treatment with placebo. Bimzelx may meet some of the needs that are important to patients, including reducing symptoms such as joint pain, clearing psoriasis, and improving health-related quality of life. Based on CADTH’s assessment of the health economic evidence, Bimzelx does not represent good value to the health care system at the public list price. The committee determined that there is insufficient evidence to justify a cost premium for Bimzelx over the least expensive bDMARD reimbursed for PsA. Based on public list prices, Bimzelx is estimated to cost the public drug plans approximately $5.7 million over the next 3 years. The estimated budget impact is sensitive to the number of patients who are expected to receive Bimzelx and the source of Bimzelx market share.
WHAT IS PSA? Arthritis is the chronic swelling and tenderness of 1 or more joints. There are different types of arthritis, 1 of which is PsA. People with PsA often have skin lesions associated with psoriasis and inflamed joints, including the joints of the arms, legs, fingers, toes, and spine. Pain and stiffness of the affected joints are the most common symptoms, and many patients also experience fatigue. The prevalence of PsA in Canada is estimated to be 1.5 per 1,000 people. UNMET NEEDS IN PSA: Although many treatments for active PsA are reimbursed in Canada, some patients may have active disease that does not respond to these treatments. Other treatment options are needed for these patients. HOW MUCH DOES BIMZELX COST? Treatment with Bimzelx is expected to cost approximately $21,198 to $27,698 per patient in the first year and $21,198 per patient in subsequent years.
