Supplementary Materials
Cost-effectiveness of Secukinumab Compared to Other Biologics in the Treatment of Ankylosing
Spondylitis in Finland
Timo Purmonen1, Kari Puolakka2, Dinesh Mishra3, Praveen Gunda3, Janne Martikainen4
1. Novartis Finland Oy, Finland
2. Rheumatologist, Chief of Department, South Karelia Central Hospital, Lappeenranta,
Finland
3. Novartis Product Lifecycle Services-NBS, Novartis Healthcare Private Limited, Hyderabad,
India
4. Professor of Pharmacoeconomics, School of Pharmacy, University of Eastern Finland,
Kuopio, Finland
Correspondence to: Timo Purmonen ([email protected])
1
Table S1: Population inputs to define baseline characteristics
Input Mean SD
Percentage male 69.5% N/A
Age (years) 42.37 N/A
Weight (kg) 78.20 16.882Notes: MEASURE 1 and MEASURE 2 study pooled trial data (data not published).Abbreviations: N/A = not applicable; SD = standard deviation.
2
Table S2: Drug dosing, mode of administration, and number of doses in each treatment period
Number of Doses
Administration Drug Dose First 3 Months Months 4-6 Subsequent 3-month Periods
Subcutaneous Secukinumab 150 mg 7.00 3.00 3.00
Certolizumab pegol 200 mg 10.00 6.00 6.52
Etanercept 50 mg 13.00 13.00 13.04
Adalimumab 40 mg 7.00 6.00 6.52
Golimumab 50 mg 3.00 3.00 3.00
Intravenous Infliximab 100 mg 3.00 2.00 1.63
Notes: Dosing information derived from Finnish Medicinal products and prices database 1 and product specific details from Summary of Product Characteristics (SPC).2-7
3
Table S3: Annual treatment-specific biologic withdrawal rates
Administration Drug Year 1 Year 2+
Subcutaneous Secukinumab 15.3% 1.6%
Certolizumab pegol 12.6% 11.0%
Etanercept 25.1% 25.1%
Adalimumab 13.0% 9.3%
Golimumab 15.1% 6.2%
Intravenous Infliximab 2.1% 15.7%
Notes: This withdrawal rates are calculated from clinical trial based on the total patients entering a given treatment arm (N) and then assessing the number of patients dropping out (n) due to reasons such as lack of efficacy/adverse events or loss to follow up at a given time point (Withdrawal rate = n/N at time t). To assess the withdrawal rate this drop out was assessed at 1 year (or closest time point available and then converted to annual rate). For withdrawal rate beyond 1st year, it was assessed at a time point >1 year and converted to annual rate. Secukinumab from MEASURE 1 and MEASURE 2 Clinical Study Report (data not published); Certolizumab pegol from Sieper et al. 2015;8 Etanercept from Dougados et al. 20129 and Navarro-Sarabia et al. 2011;10 Adalimumab from van der Heijde et al. 200611 and Sieper et al. 2012;12; Infliximab from van der Heijde et al. 200613 and Braun et al. 2008;14 Golimumab from Deodhar et al 2015.15
4
Table S4: Medical support costsParameters First 3 months Subsequent 3-
month PeriodsCost per test
Medical visit
Specialist 2.00 0.25 € 314.04 [a]
Laboratory test
Full blood count 2.00 0.50 € 2.57 [a]
C-reactive protein 2 0.5 € 1.50 [a]
Erythrocyte sedimentation rate (ESR) 2.00 0.25 € 4.07 [a]
Liver function test 2.00 0.50 € 3.21 [a]
Creatinine test 1.00 0.25 € 1.39 [a]
Chest radiograph 1.00 0.00 € 35.49 [a]
Tuberculosis (TB) Heaf test 1.00 0.00 € 50.00 [b]
Notes: Frequency for laboratory tests is based on local expert opinion. For cost:16
[a] Kapiainen S, Väisänen A, Haula T. Terveyden- ja sosiaalihuollon yksikkökustannukset Suomessa vuonna 2011. (Social- and health care unit costs in Finland in 2011). Report of National Institute for Health and Welfare, Helsinki, 2014. http://www.julkari.fi/ handle/10024/114683. Unit costs indexed to year 2016 value.[b] The Finnish society for rheumatology (test 6173)
5
Table S5: Adverse event rates per 3 months
Administration Adverse Event Serious Infection Malignancy
Subcutaneous Secukinumab 0.16% 0.0015%
Certolizumab pegol 0.67% 0.0000%
Etanercept 0.00% 0.0000%
Adalimumab 0.35% 0.1249%
Golimumab 0.19% 0.0309%
Intravenous Infliximab 0.52% 0.1278%
Notes: Adverse event data for different treatments were obtained from clinical trials as mentioned below.Secukinumab from MEASURE 1 and MEASURE 2 trial (unpublished data); Certolizumab pegol from Sieper et al. 20158
Etanercept from Braun et al 201117
Adalimumab from Burmester et al. 201318
Infliximab from Braun et al. 2008 14 and van der Heijde et al. 200513
Golimumab from Deodhar et al 201515
6
Table S6: Adverse event related costs
Adverse event Cost per event
Tuberculosis € 14,445*[a]
Other serious infection € 3,013.10 [a]
Malignancy € 24,832.00 [b]
Notes: *Care consisting of 14 days hospital care and monthly 1 year follow up in specialized health care unit. [a] Kapiainen et al 2014;16 [b] Torkki et al 2017.19 Unit costs indexed to year 2016 value.
7
Table S7: Utility weight inputs used in the model to calculate QALYs
Parameter MEASURE 1 / 2 Data* McLeod et al. 2007 [20]
Intercept 0.9610 0.8772
BASFI coefficient -0.0330 -0.0323
BASDAI coefficient -0.0442 -0.0384
Male coefficient -0.0111 -0.0279
Age coefficient -0.0005 0.0017
Notes: Secukinumab from Novartis Data on File 2015a: MEASURE 1 Clinical Study Report and MEASURE 2 Clinical Study Report (unpublished data)*Utilities calculated from MEASURE 1 and MEASURE 2 pooled trial data (data not published)For base-case analysis, utilities calculated from MEAURE 1 and 2 trials are included. For alternative scenario analysis, utilities obtained from McLeod et al. 200720 are included.Abbreviations: BASDAI = Bath Ankylosing Spondylitis Disease Activity Index; BASFI = Bath Ankylosing Spondylitis Functional Index
8
Table S8: Disease-specific and adverse event related mortality inputs considered in the analysis
Input Relative Risk
Disease specific mortalityMale 1.63Female 1.38
Adverse EventTuberculosis 1.65Other serious infection 1.65Malignancy
1 year 1.412 years 1.41
Notes: Disease-specific mortality data obtained from Bakland et al. 201121
Mortality data for adverse event obtained from Abuabara et al. 201022
9
Table S9: Sensitivity analysis inputs for biologic-naive base-case population
Parameter Base case
Lower Bound
Upper Bound
Standard Error Distribution used in probabilistic
sensitivity analysis
Discount rate - costs 3.00% 0.0% 5.0% Not variedDiscount rate - outcomes 3.00% 0.0% 5.0% Not variedBaseline BASDAI 6.75 5.40 8.10 Not variedBaseline BASFI 6.38 5.10 7.65 Not variedBaseline BASDAI responders: SEC 6.23 4.98 7.47 Not variedBaseline BASDAI responders: CER P
6.23 4.98 7.47 Not varied
Baseline BASDAI responders: ETN 6.23 4.98 7.47 Not variedBaseline BASDAI responders: ADA
6.23 4.98 7.47 Not varied
Baseline BASDAI responders: INF 6.23 4.98 7.47 Not variedBaseline BASDAI responders: GOL 6.23 4.98 7.47 Not variedBaseline BASDAI non-responders: SEC
6.90 5.52 8.28 Not varied
Baseline BASDAI non-responders: CER P
6.90 5.52 8.28 Not varied
Baseline BASDAI non-responders: ETN
6.90 5.52 8.28 Not varied
Baseline BASDAI non-responders: ADA
6.90 5.52 8.28 Not varied
Baseline BASDAI non-responders: INF
6.90 5.52 8.28 Not varied
Baseline BASDAI non-responders: GOL
6.90 5.52 8.28 Not varied
Baseline BASFI responders: SEC 5.69 4.55 6.83 Not variedBaseline BASFI responders: CER P 5.69 4.55 6.83 Not variedBaseline BASFI responders: ETN 5.69 4.55 6.83 Not variedBaseline BASFI responders: ADA 5.69 4.55 6.83 Not variedBaseline BASFI responders: INF 5.69 4.55 6.83 Not variedBaseline BASFI responders: GOL 5.69 4.55 6.83 Not variedBaseline BASFI non-responders: SEC
6.83 5.47 8.20 Not varied
Baseline BASFI non-responders: CER P
6.83 5.47 8.20 Not varied
Baseline BASFI non-responders: ETN
6.83 5.47 8.20 Not varied
Baseline BASFI non-responders: ADA
6.83 5.47 8.20 Not varied
Baseline BASFI non-responders: INF
6.83 5.47 8.20 Not varied
Baseline BASFI non-responders: GOL
6.83 5.47 8.20 Not varied
Annual rate of MSASSS change 1.440 1.152 1.728 0.133 Normal
10
Parameter Base case
Lower Bound
Upper Bound
Standard Error Distribution used in probabilistic
sensitivity analysis
for MSASSS≥10 - SECAnnual rate of MSASSS change for MSASSS≥10 - TNFs
1.440 1.152 1.7280.133
Normal
BASFI change with 1 unit change in MSASSS
0.057 0.046 0.0680.005
Normal
Treatment effect on progression - SEC
0.153 0.122 0.1840.044
Normal
Treatment effect on progression - TNFs
0.420 0.336 0.5040.122
Normal
Relative risk BASDAI response: Second line
1.00 0.80 1.20 - Not varied
Relative risk Δ BASDAI: Second line
1.00 0.80 1.20 - Not varied
Relative risk Δ BASFI: Second line 1.00 0.80 1.20 - Not variedDiscontinuation year 1: SEC 15.3% 12.3% 18.4% 0.031 NormalDiscontinuation year 1: CER P 12.6% 10.1% 15.1% 0.025 NormalDiscontinuation year 1: ETN 25.1% 20.1% 30.2% 0.050 NormalDiscontinuation year 1: ADA 13.0% 10.4% 15.7% 0.026 NormalDiscontinuation year 1: INF 2.1% 1.7% 2.6% 0.004 NormalDiscontinuation year 1: GOL 15.1% 12.1% 18.1% 0.030 NormalDiscontinuation year 2: SEC 1.6% 1.3% 2.0% 0.003 NormalDiscontinuation year 2: CER P 11.0% 8.8% 13.2% 0.022 NormalDiscontinuation year 2: ETN 25.1% 20.1% 30.2% 0.050 NormalDiscontinuation year 2: ADA 9.3% 7.5% 11.2% 0.019 NormalDiscontinuation year 2: INF 15.7% 12.6% 18.9% 0.031 NormalDiscontinuation year 2: GOL 6.2% 4.9% 7.4% 0.012 NormalDrug acquisition cost: SEC €584.43 €467.54 €701.32 - Not variedDrug acquisition cost: CER P €483.07 €386.45 €579.68 - Not variedDrug acquisition cost: ETN €260.04 €208.03 €312.04 - Not variedDrug acquisition cost: ADA €527.41 €421.93 €632.89 - Not variedDrug acquisition cost: INF €436.06 €348.85 €523.27 - Not variedDrug acquisition cost: GOL €
1,086.93€869.54 €
1,304.32 -
Not varied
SC administration training €51.47 €41.18 €61.76 10.29 NormalIV administration €382.00 €305.60 €458.40 76.40 NormalDisease related cost intercept €
1,508.99€
1,207.19
€1,810.7
9 0.165
Log-normal
BASFI coefficient 0.21 0.17 0.26 0.038 NormalTuberculosis cost €14,445.
00€11,556.
00€17,334.
00 2889.000Gamma
Other serious infection cost €3,013.10
€2,410.48
€3,615.72 602.60
Gamma
11
Parameter Base case
Lower Bound
Upper Bound
Standard Error Distribution used in probabilistic
sensitivity analysis
Malignancy cost €24,832.00
€19,865.60
€29,798.40 4966.400
Gamma
GP visit cost €118.06 €94.45 €141.67 23.612 GammaSpecialist visit cost €314.04 €251.23 €376.85 62.808 GammaFull blood count cost €2.57 €2.06 €3.08 0.514 GammaErythrocyte sedimentation rate cost
€4.07 €3.26 €4.880.814
Gamma
Liver function test cost €3.21 €2.57 €3.85 0.642 GammaC-reactive protein cost €1.50 €1.20 €1.80 0.300 GammaChest radiograph cost €35.49 €28.39 €42.59 7.098 GammaTuberculosis Heaf test cost €50.00 €40.00 €60.00 10.000 GammaCreatinine test cost €1.39 €1.11 €1.67 0.278 GammaSerious infection probability: SEC 0.16% 0.13% 0.20% 0.000327 BetaSerious infection probability: CER P
0.67% 0.54% 0.81%0.001345
Beta
Serious infection probability: ETN 0.00% 0.00% 0.00% 0.000000 BetaSerious infection probability: ADA 0.35% 0.28% 0.42% 0.000699 BetaSerious infection probability: INF 0.52% 0.41% 0.62% 0.001036 BetaSerious infection probability: GOL 0.19% 0.15% 0.23% 0.000377 BetaMalignancy probability: SEC 0.00% 0.00% 0.00% 0.000003 BetaMalignancy probability: CER P 0.00% 0.00% 0.00% 0.000000 BetaMalignancy probability: ETN 0.00% 0.00% 0.00% 0.000000 BetaMalignancy probability: ADA 0.12% 0.10% 0.15% 0.000250 BetaMalignancy probability: INF 0.13% 0.10% 0.15% 0.000256 BetaMalignancy probability: GOL 0.03% 0.02% 0.04% 0.000062 BetaAS mortality relative risk - males 1.63 1.30 1.96 0.326000 Log-normalAS mortality relative risk - females
1.38 1.10 1.660.276000
Log-normal
Tuberculosis mortality relative risk
1.65 1.32 1.98 - Not varied
Other serious infection mortality relative risk
1.65 1.32 1.98 - Not varied
Malignancy relative risk: Year 1 1.41 1.13 1.69 - Not variedMalignancy relative risk: Year 2 1.41 1.13 1.69 - Not variedUtility intercept 0.961 0.77 1.15 0.192 NormalUtility BASFI coefficient -0.0330 -0.0264 -0.0396 0.007 NormalUtility BASDAI coefficient -0.0442 -0.0354 -0.0530 0.009 NormalUtility male coefficient -0.0111 -0.0089 -0.0133 0.002 NormalUtility age coefficient -0.0005 -0.0004 -0.0006 0.0001 NormalSerious infection disutility: Year 1 -0.1560 -0.1248 -0.1872 0.031 NormalSerious infection disutility: Year 2 0.0000 0.0000 0.0000 0.000 NormalSerious infection disutility: Years 0.0000 0.0000 0.0000 0.000 Normal
12
Parameter Base case
Lower Bound
Upper Bound
Standard Error Distribution used in probabilistic
sensitivity analysis
3+Malignancy disutility -0.0174 -0.0139 -0.0209 0.003 Normal
Log Odds SEBASDAI 50 at 3 months: SEC 41.53% 15.21% 73.77% 0.702 NormalBASDAI 50 at 3 months: CER P 44.20% 19.27% 72.44% 0.612 NormalBASDAI 50 at 3 months: ETN 36.80% 14.92% 65.89% 0.612 NormalBASDAI 50 at 3 months: ADA 48.85% 38.43% 59.37% 0.217 NormalBASDAI 50 at 3 months: INF 44.20% 19.27% 72.44% 0.612 NormalBASDAI 50 at 3 months: GOL 47.20% 28.39% 66.85% 0.415 Normal
SE3-month responder BASDAI change: SEC -4.602 -2.982 -6.222 0.449
Normal
3-month responder BASDAI change: CER P -5.569 -4.010 -7.127 0.453
Normal
3-month responder BASDAI change: ETN -4.474 -2.743 -6.206 0.453
Normal
3-month responder BASDAI change: ADA -4.562 -3.970 -5.155 0.175
Normal
3-month responder BASDAI change: INF -7.941 -5.836 -10.046 0.612
Normal
3-month responder BASDAI change: GOL -5.316 -4.004 -6.629 0.407
Normal
3-month non-responder BASDAI change: SEC -1.007 -0.652 -1.361 0.449
Normal
3-month non-responder BASDAI change: CER P -1.275 -0.886 -1.575 0.453
Normal
3-month non-responder BASDAI change: ETN -1.025 -0.608 -1.375 0.453
Normal
3-month non-responder BASDAI change: ADA -0.806 -0.837 -1.087 0.175
Normal
3-month non-responder BASDAI change: INF -1.819 -1.290 -2.220 0.612
Normal
3-month non-responder BASDAI change: GOL -1.368 -0.906 -1.500 0.407
Normal
3-month responder BASFI change: SEC -3.748 -2.294 -5.202 0.444
Normal
3-month responder BASFI change: CER P -3.594 -2.211 -4.978 0.409
Normal
3-month responder BASFI change: ETN -3.444 -1.914 -4.975 0.409
Normal
3-month responder BASFI change: ADA -3.145 -2.622 -3.668 0.164
Normal
3-month responder BASFI change: INF -3.965 -2.119 -5.811 0.546
Normal
13
Parameter Base case
Lower Bound
Upper Bound
Standard Error Distribution used in probabilistic
sensitivity analysis
3-month responder BASFI change: GOL -4.072 -2.816 -5.327 0.362
Normal
3-month non-responder BASFI change: SEC -1.174 -0.718 -1.629 0.444
Normal
3-month non-responder BASFI change: CER P -0.886 -0.651 -1.465 0.409
Normal
3-month non-responder BASFI change: ETN -0.849 -0.555 -1.442 0.409
Normal
3-month non-responder BASFI change: ADA -0.775 -0.778 -1.089 0.164
Normal
3-month non-responder BASFI change: INF -0.977 -0.624 -1.710 0.546
Normal
3-month non-responder BASFI change: GOL -0.712 -0.781 -1.477 0.362
Normal
14
Abbreviations: ADA = adalimumab; ETN = etanercept; CER P = certolizumab pegol; INF = infliximab; GOL = golimumab; SEC = secukinumab; BASDAI = Bath Ankylosing Spondylitis Disease Activity Index; BASFI = Bath Ankylosing Spondylitis Functional Index.Table S10: Disaggregated costs contributing to total costs for each treatment
COSTS SEC CER P ETN ADA INF GOLTotal cost 279,872
€309,257
€305,883
€312,139
€316,291
€309,551
€Drug cost for patients on primary drug 41,895 € 40,857 € 19,314 € 49,523 € 39,410 € 54,937 €
Drug cost post discontinuation126,594
€147,722
€160,795
€141,268
€147,138
€138,122
€Background disease cost for patients on primary drug 13,533 € 7,831 € 3,659 € 12,936 € 9,344 € 10,630 €
Background disease cost post discontinuation 84,839 € 98,794 €107,896
€ 94,414 € 98,414 € 92,298 €
Administration cost for patients on primary drug 51 € 51 € 51 € 51 € 7,828 € 51 €
Administration costs post discontinuation 5,035 € 5,872 € 6,392 € 5,615 € 5,849 € 5,491 €
Monitoring cost for patients on primary drug 2,536 € 1,693 € 1,128 € 1,851 € 1,623 € 2,059 €
Monitoring cost post discontinuation 4,040 € 4,714 € 5,131 € 4,508 € 4,695 € 4,407 €Serious infection for patients on primary drug 148 € 330 € 0 € 199 € 237 € 127 €
Serious infection post discontinuation 630 € 734 € 800 € 702 € 732 € 687 €
Malignancy cost for patients on primary drug 8 € 0 € 0 € 442 € 366 € 128 €
Malignancy cost post discontinuation 564 € 658 € 717 € 630 € 656 € 616 €
15
Table S11: Probabilistic sensitivity analysis results*
Outcome SEC CER P ETN ETN biosimilar
ADA ADA biosimilar
INF GOL
Total cost Mean (Euros)
279,716 309,764 305,961 301,284 312,321 297,383 317,998 309,938
Total QALYs Mean (years)
13.279 12.818 12.355 12.095 12.676 12.584 12.825 12.786
NMB Mean (Euros)
118,668 74,786 67,718 61,568 67,965 80,124 66,762 82,370
Max NMB 95.0% 1.0% 0,0% 0.0% 0.0% 0.10% 0.0% 4.0%*Derived at Willingness-to-Pay threshold of €30,000.Abbreviations: ADA = adalimumab; ETN = etanercept; CER P = certolizumab pegol; INF = infliximab; GOL = golimumab; SEC = secukinumab; NMB = net monetary benefit; SD = standard deviation; QALY = quality-adjusted life-year.
Alternative scenario analysis: Detailed results
Table S12: Population: Biologic-naïve and biologic-experienced population
Administration Treatment Total costs (€)
QALYs ICERSEC vs others
Subcutaneous Secukinumab 288,539 11.9
Certolizumab pegol
312,325 11.6 SEC Dominates
Etanercept 308,761 11.2 SEC Dominates
Etanercept biosimilar
303,837 11. 2 SEC Dominates
Adalimumab 314,395 11.4 SEC Dominates
Adalimumab biosimilar 302,283 € 11.4
SEC Dominates
Golimumab 312,577 11.8 SEC Dominates
Intravenous Infliximab 317,944 11.6 SEC Dominates
Table S13: Utility from McLeod et al20
Administration Treatment Total costs (€)
QALYs ICERSEC vs others
Subcutaneous Secukinumab 279,872 14.2
16
Certolizumab pegol
309,257 13.8 SEC Dominates
Etanercept 305,883 13.4 SEC Dominates
Etanercept biosimilar
300,075 13.4 SEC Dominates
Adalimumab 312,139 13.7 SEC Dominates
Adalimumab biosimilar
297,282 13.7 SEC Dominates
Golimumab 309,551 14.0 SEC Dominates
Intravenous Infliximab 316,291 13.8 SEC Dominates
Table S14: Disutility included*
Administration Treatment Total costs (€)
QALYs ICERSEC vs others
Subcutaneous Secukinumab 279,872 13.1
Certolizumab pegol
309,257 12.6 SEC Dominates
Etanercept 305,883 12.1 SEC Dominates
Etanercept biosimilar
300,075 12.1 SEC Dominates
Adalimumab 312,139 12.5 SEC Dominates
Adalimumab biosimilar
297,282 12.5 SEC Dominates
Golimumab 309,551 12.9 SEC Dominates
Intravenous Infliximab 316,291 12.6 SEC Dominates
* Despite including disutilities, there was not major difference in result compared to baseline due to very minor impact.
Table S15: BASFI rebound assumption: Initial gain
Administration Treatment Total costs (€)
QALYs ICERSEC vs others
Subcutaneous Secukinumab 261,817 13.5
Certolizumab pegol
288,165 13.1 SEC Dominates
Etanercept 282,873 12.7 SEC Dominates
Etanercept biosimilar
277,066 12.7 SEC Dominates
Adalimumab 291,181 12.98 SEC Dominates
17
Adalimumab biosimilar
276,324 12.98 SEC Dominates
Golimumab 289,639 13.38 SEC Dominates
Intravenous Infliximab 294,604 13.2 SEC Dominates
Table S16: Indirect cost included
Administration Treatment Total costs (€)
QALYs ICERSEC vs others
Subcutaneous Secukinumab 561,562 13.1
Certolizumab pegol
600,318 12.6 SEC Dominates
Etanercept 602,292 12.1 SEC Dominates
Etanercept biosimilar
300,075 12.1 $261,487
Adalimumab 598,532 12.5 SEC Dominates
Adalimumab biosimilar
297,282 12.5 $440,467
Golimumab 595,678 12.9 SEC Dominates
Intravenous Infliximab 603,621 12.6 SEC Dominates
Table S17: Disease related cost excluded
Administration Treatment Total costs (€)
QALYs ICERSEC vs others
Subcutaneous Secukinumab 181,501 13.1
Certolizumab pegol
202,632 12.6 SEC Dominates
Etanercept 194,328 12.1 SEC Dominates
Etanercept biosimilar
188,521 12.1 SEC Dominates
Adalimumab 204,789 12.5 SEC Dominates
Adalimumab biosimilar
189,932 12.5 SEC Dominates
Golimumab 206,624 12.9 SEC Dominates
Intravenous Infliximab 208,534 12.6 SEC Dominates
18
Figure S1: One-way sensitivity analysis: Secukinumab 150 mg (biologic-naïve population)
Secukinumab versus certolizumab pegol
0 € 10,000 € 20,000 € 30,000 € 40,000 € 50,000 € 60,000 € 70,000 € 80,000 € 90,000 € 100,000 €
BASDAI 50 at 3 months: SEC
Baseline BASFI non-responders: CER P
Baseline BASFI non-responders: SEC
3-month responder BASFI change: SEC
3-month responder BASDAI change: SEC
Discount rate - outcomes
Discount rate - costs
Drug acquisition cost: CER P
Baseline BASFI responders: SEC
Baseline BASDAI responders: SEC
Incremental Net Monetary Benefit
High NMB
Low NMB
Secukinumab versus etanercept
0 € 20,000 € 40,000 € 60,000 € 80,000 € 100,000 € 120,000 €
Baseline BASFI non-responders: ETN
BASDAI 50 at 3 months: SEC
Baseline BASFI non-responders: SEC
Discount rate - outcomes
3-month responder BASFI change: SEC
3-month responder BASDAI change: SEC
Discount rate - costs
Baseline BASFI responders: SEC
Baseline BASDAI responders: SEC
Drug acquisition cost: SEC
Incremental Net Monetary Benefit
High NMB
Low NMB
Secukinumab versus etanercept biosimilar
0 € 20,000 € 40,000 € 60,000 € 80,000 € 100,000 € 120,000 €
Baseline BASFI non-responders: ETN
BASDAI 50 at 3 months: SEC
Baseline BASFI non-responders: SEC
Discount rate - outcomes
Discount rate - costs
3-month responder BASFI change: SEC
3-month responder BASDAI change: SEC
Baseline BASFI responders: SEC
Baseline BASDAI responders: SEC
Drug acquisition cost: SEC
Incremental Net Monetory Benefit
High NMB
Low NMB
19
Secukinumab versus adalimumab
0 € 20,000 € 40,000 € 60,000 € 80,000 € 100,000 € 120,000 €
BASDAI 50 at 3 months: SEC
Baseline BASFI non-responders: ADA
Baseline BASFI non-responders: SEC
Discount rate - outcomes
3-month responder BASFI change: SEC
3-month responder BASDAI change: SEC
Discount rate - costs
Drug acquisition cost: ADA
Baseline BASFI responders: SEC
Baseline BASDAI responders: SEC
Incremental Net Monetary Benefit
High NMB
Low NMB
Secukinumab versus adalimumab biosimilar
0 € 10,000 € 20,000 € 30,000 € 40,000 € 50,000 € 60,000 € 70,000 € 80,000 € 90,000 € 100,000 €
BASDAI 50 at 3 months: SEC
Baseline BASFI non-responders: ADA
Baseline BASFI non-responders: SEC
Discount rate - outcomes
Discount rate - costs
3-month responder BASFI change: SEC
3-month responder BASDAI change: SEC
Baseline BASFI responders: SEC
Baseline BASDAI responders: SEC
Drug acquisition cost: SEC
Incremental Net Monetory Benefit
High NMB
Low NMB
Secukinumab versus infliximab
0 € 20,000 € 40,000 € 60,000 € 80,000 € 100,000 € 120,000 €
BASDAI 50 at 3 months: SEC
Baseline BASFI non-responders: INF
Baseline BASFI non-responders: SEC
Discount rate - outcomes
3-month responder BASFI change: SEC
3-month responder BASDAI change: SEC
Discount rate - costs
Baseline BASFI responders: SEC
Baseline BASDAI responders: SEC
Drug acquisition cost: INF
Incremental Net Monetary Benefit
High NMB
Low NMB
20
Secukinumab versus golimumab
-10,000 € 0 € 10,000 € 20,000 € 30,000 € 40,000 € 50,000 € 60,000 € 70,000 € 80,000 € 90,000 €
BASDAI 50 at 3 months: SEC
Baseline BASFI non-responders: GOL
Baseline BASFI non-responders: SEC
3-month responder BASFI change: SEC
Drug acquisition cost: GOL
3-month responder BASDAI change: SEC
Discount rate - costs
Baseline BASFI responders: SEC
Baseline BASDAI responders: SEC
Drug acquisition cost: SEC
Incremental Net Monetary Benefit
High NMB
Low NMB
Abbreviations: ADA = adalimumab; BASDAI = Bath Ankylosing Spondylitis Disease Activity Index; BASFI = Bath Ankylosing Spondylitis Functional Index; CER P = certolizumab pegol; ETN = etanercept; GOL = golimumab; INF = infliximab; NMB = Net monetary benefit; SEC = secukinumab.
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