Cost Per Responder of Bimekizumab Against Il-17A, IL-12/23 and IL-23 Inhibitors in the Treatment of Psoriatic Arthritis in Sweden

OBJECTIVES: To assess the cost per responder of bimekizumab, a selective inhibitor of interleukin (IL)-17F in addition to IL-17A, by prior biologic exposure, against approved IL-17A, IL-23, and IL-12/23 inhibitors for patients with psoriatic arthritis (PsA) in Sweden.

METHODS: A cost per responder model was developed based on BE OPTIMAL and BE COMPLETE bimekizumab trials, including patients naïve to biologic disease-modifying anti-rheumatic drugs (biologic-naïve) and patients with experience of at least one previous tumor necrosis factor inhibitor (TNFi-exp). Treatments included were bimekizumab 160 mg Q4W, guselkumab 100 mg Q4W, ixekizumab 80 mg Q4W, risankizumab 150 mg Q12W, secukinumab 150 mg Q4W and ustekinumab 45 mg/90 mg. Efficacy outcomes assessed were American College of Rheumatology (ACR)50, Psoriasis Area and Severity Index (PASI)100 (complete response) and Minimal Disease Activity (MDA) at 16 weeks. Drug acquisition costs obtained from the Dental and Pharmaceutical Benefits Agency’s (TLV) database (February 2023) were used to calculate total cost per patient over 16 weeks. Response rates derived from a network meta-analysis were used to calculate number-needed-to-treat, which were multiplied with total cost per patient for each intervention to obtain cost per response.

RESULTS: For ACR50, bimekizumab had the lowest cost per response (8.025€ for biologic-naïve; 7.327€ for TNFi-exp), whereas the highest cost was guselkumab for biologic-naïve (29.082€) and ustekinumab 45 mg for TNFi-exp (32.786€). For PASI100, bimekizumab had the lowest cost (7.171€ and 5.811€), whereas the highest cost was secukinumab for biologic-naïve (18.925€) and ixekizumab for TNFi-exp (26.659€). For MDA, bimekizumab had the lowest cost for both subgroups (8.869€ and 7.660€), the highest cost was guselkumab for biologic-naïve (30.293€) and risankizumab for TNFi-exp (25.757€).

CONCLUSIONS: Treatment with bimekizumab for patients with PsA at Week 16 is associated with the lowest cost per response versus IL-17A and IL-23 inhibitors for ACR50, PASI100 and MDA, regardless of prior biologic exposure.