PMID- 32792421
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20231112
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 10
IP  - 8
DP  - 2020 Aug 13
TI  - Cost-effectiveness analysis of ixekizumab versus secukinumab in patients with 
      psoriatic arthritis and concomitant moderate-to-severe psoriasis in Spain.
PG  - e032552
LID - 10.1136/bmjopen-2019-032552 [doi]
LID - e032552
AB  - OBJECTIVE: To conduct a cost-effectiveness analysis from the perspective of the 
      Spanish National Health System (NHS) comparing ixekizumab versus secukinumab. 
      DESIGN: A Markov model with a lifetime horizon and monthly cycles was developed 
      based on the York model. Four health states were included: a biological 
      disease-modifying antirheumatic drug (bDMARD) induction period of 12 or 16 weeks, 
      maintenance therapy, best supportive care (BSC) and death. Treatment response was 
      assessed based on both Psoriatic Arthritis Response Criteria (PsARC) and >/=90% 
      improvement in the Psoriasis Area Severity Index score (PASI90). At the end of 
      the induction period, responders transitioned to maintenance therapy. 
      Non-responders and patients who discontinued maintenance therapy transitioned to 
      BSC. Clinical efficacy data were derived from a network meta-analysis. Health 
      utilities were generated by applying a regression analysis to Psoriasis Area 
      Severity Index and Health Assessment Questionnaire‒Disability Index scores 
      collected in the ixekizumab SPIRIT studies. Results were subject to extensive 
      sensitivity and scenario analysis. SETTING: Spanish NHS. PARTICIPANTS: A 
      hypothetical cohort of bDMARD-naive patients with psoriatic arthritis and 
      concomitant moderate-to-severe psoriasis was modelled. INTERVENTIONS: Ixekizumab 
      and secukinumab. RESULTS: Ixekizumab performed favourably over secukinumab in the 
      base-case analysis, although cost savings and quality-adjusted life-year (QALY) 
      gains were modest. Total costs were euro153 901 compared with euro156 559 for 
      secukinumab (difference -euro2658). Total QALYs were 9.175 vs 9.082 (difference 
      0.093). Base-case results were most sensitive to the annual bDMARD 
      discontinuation rate and the modification of PsARC and PASI90 response to 
      ixekizumab or secukinumab. CONCLUSION: Ixekizumab provided more QALYs at a lower 
      cost than secukinumab, with differences being on a relatively small scale. 
      Sensitivity analysis showed that base-case results were generally robust to 
      changes in most input parameters. TRIAL REGISTRATION NUMBER: SPIRIT-P1: 
      NCT01695239; Post-results, SPIRIT-P2: NCT02349295; Post-results.
CI  - (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Schweikert, Bernd
AU  - Schweikert B
AD  - Real World Evidence Strategy and Analytics, Commercialisation and Outcomes, ICON, 
      Munich, Germany Bernd.Schweikert@iconplc.com.
FAU - Malmberg, Chiara
AU  - Malmberg C
AD  - Access, Commercialisation and Communications, ICON, Munich, Germany.
FAU - Nunez, Mercedes
AU  - Nunez M
AUID- ORCID: 0000-0003-2675-0945
AD  - Health Outcomes and Real World Evidence, Eli Lilly and Company, Madrid, Spain.
FAU - Dilla, Tatiana
AU  - Dilla T
AD  - Global Patient Outcomes and Real World Evidence International, Eli Lilly and 
      Company, Madrid, Spain.
FAU - Sapin, Christophe
AU  - Sapin C
AD  - European Statistics, Eli Lilly and Company, Neuilly-sur-Seine, France.
FAU - Hartz, Susanne
AU  - Hartz S
AD  - Global Patient Outcomes and Real World Evidence International, Eli Lilly and 
      Company, Windlesham, UK.
LA  - eng
SI  - ClinicalTrials.gov/NCT01695239
SI  - ClinicalTrials.gov/NCT02349295
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200813
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - BTY153760O (ixekizumab)
RN  - DLG4EML025 (secukinumab)
SB  - IM
MH  - Antibodies, Monoclonal/therapeutic use
MH  - Antibodies, Monoclonal, Humanized
MH  - *Arthritis, Psoriatic/drug therapy
MH  - Cost-Benefit Analysis
MH  - Humans
MH  - Markov Chains
MH  - Network Meta-Analysis
MH  - *Psoriasis/drug therapy
MH  - Spain
PMC - PMC7430486
OTO - NOTNLM
OT  - Spanish population
OT  - biologics
OT  - cost-effectiveness analysis
OT  - ixekizumab
OT  - psoriatic arthritis
OT  - secukinumab
COIS- Competing interests: BS and CM are full-time employees of ICON who were 
      commissioned by Eli Lilly and Company to conduct the analysis for this work. MN, 
      TD, CS and SH are full-time employees of Eli Lilly and Company; they receive a 
      salary and own company stock.
EDAT- 2020/08/15 06:00
MHDA- 2021/05/15 06:00
PMCR- 2020/08/13
CRDT- 2020/08/15 06:00
PHST- 2020/08/15 06:00 [entrez]
PHST- 2020/08/15 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2020/08/13 00:00 [pmc-release]
AID - bmjopen-2019-032552 [pii]
AID - 10.1136/bmjopen-2019-032552 [doi]
PST - epublish
SO  - BMJ Open. 2020 Aug 13;10(8):e032552. doi: 10.1136/bmjopen-2019-032552.