To study the cost-effectiveness of an interleukin (IL)-17A inhibitor secukinumab, with other biologics and apremilast in patients with Psoriatic arthritis (PsA) from the payer perspective in Finland.

In this semi-Markov model, subcutaneous (SC) secukinumab was compared with SC treatments etanercept and its biosimilar, certolizumab pegol, adalimumab and its biosimilar, golimumab, ustekinumab, intravenous (IV) treatment infliximab, as well as oral non-biologic apremilast. Patients without prior exposure (naïve) to biologics and without moderate to severe psoriasis were considered for secukinumab 150 mg group.

Secukinumab 300 mg group included naïve patients with moderate to severe psoriasis and all patients with prior biologic exposure. The PsA Response Criteria (PsARC) at 12-week was the primary criteria for treatment response. Other clinical, as well as cost related model inputs, were derived from relevant clinical trials as well as Finnish publications.

The key model outcomes were quality-adjusted life years and incremental cost-effectiveness ratio. An annual 3% discount rate was applied to all future costs and benefits. Model input variations were assessed through sensitivity analyses and alternative scenario analyses.

For a lifetime horizon (60 years), secukinumab 150 mg dominated all branded SC biologics and apremilast with highest QALY of 8.01 and lowest lifetime cost of €187,776, while it was cost-effective against IV infliximab among biologic-naïve patients without moderate to severe psoriasis.

Hospitalization costs and diagnosis costs

Secukinumab 300 mg was cost-effective against all branded SC biologics and apremilast and dominated IV infliximab among biologic-naïve patients with moderate to severe psoriasis, while it was cost-effective in biologic experienced patients.

With the one-way sensitivity analysis, PsARC response, drug acquisition cost, and the health assessment questionnaire score were the most important parameters affecting the outcomes.

Across all treatment groups, patients on secukinumab were most likely to achieve the highest net monetary benefit than other competitors in probabilistic sensitivity analysis. With alternative scenario analysis, results largely remained unchanged.

The strength of this analysis can be attributed to various factors. The clinical inputs in the model were taken from an NMA, consisting of 6021 patients in 20 RCTs. Patients in this NMA were a mix of those with and without prior biologic exposure, which makes clinical inputs in this model reliable.

The inclusion of costs like hospitalization costs and diagnosis costs, in addition to drug acquisition and adverse event costs, allows comprehensive representation of the direct economic burden of PsA.

Secukinumab is a cost-effective treatment for PsA patients from a Finnish payer's perspective. Patients on secukinumab achieved highest gains in the quality-adjusted life-years against all comparators regardless of secukinumab dose, the severity of concomitant psoriasis, or prior exposure to biologics.

Secukinumab was either cost-saving or cost-effective when compared with the currently used alternative treatment options for the treatment of active Psoriatic arthritis from a player's perspective in Finland.