ECONOMIC EVALUATION OF BIOLOGIC TREATMENT SEQUENCES IN SYSTEMIC LUPUS ERYTHEMATOSUS IN SPAIN
Author(s)
Belén Citoler, M.Sc.1, Joaquin Borrás Blasco, Ph.D.2, Alberto Jiménez, Ph.D.3, Fernando de Andrés-Nogales, M.Sc.4, Covadonga Torres, 4.
1Outcomes'10 (a ProductLife Group Company), Castellon, Spain, 2Sagunto Hospital, Sagunto, Spain, 3Virgen de las Nieves Hospital, Granada, Spain, 4AstraZeneca, Madrid, Spain.
1Outcomes'10 (a ProductLife Group Company), Castellon, Spain, 2Sagunto Hospital, Sagunto, Spain, 3Virgen de las Nieves Hospital, Granada, Spain, 4AstraZeneca, Madrid, Spain.
OBJECTIVES: Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease associated with recurrent flares, organ damage, and high morbidity. Both belimumab and anifrolumab are biologics approved in Europe for intravenous (IV) and subcutaneous (SC) administration in patients with moderate-to-severe SLE. This study assessed the clinical and economic impact of alternative biologic treatment sequences (first and second-line) for SLE in Spain.
METHODS: A cohort-based decision model was developed to simulate treatment sequences in patients with SLE eligible for biologic therapy (n=5,858). The model compared sequences starting with SC anifrolumab versus SC belimumab over a 12‑month time horizon, incorporating first and second-line treatment transitions driven by discontinuation rates from Spanish real-world evidence (RWE) studies (RELES and AZAHAR for anifrolumab; BEL-Spain and OBSErve-Spain for belimumab). Flares were included in the model, using rates derived from anifrolumab (Pooled TULIP, TULIP-SC) and belimumab (BLISS-76, BLISS-SC) clinical trials. Direct healthcare costs(€,2026) were estimated from the Spanish National Health System, including pharmacological and flare costs. Outcomes included total costs, cost per patient and cost per responder. Sensitivity analyses explored alternative price assumptions, flare data sources (indirect comparison and RWE), SC/IV treatment distributions compared with the 100%SC base case, and the societal perspective.
RESULTS: Initiating biologic treatment with SC anifrolumab was associated with lower total costs than starting with SC belimumab (€98.7M vs €105.3M), generating savings of €6.7M (−6%), equivalent to €1,136 per patient. The anifrolumab-initiated sequence was also associated with fewer flares (−69%) and had a lower cost per responder (€17,932 vs €19,652), representing a 9% reduction. Sensitivity analyses showed consistent results, with cost savings maintained across alternative assumptions and under the societal perspective.
CONCLUSIONS: A treatment sequence initiated with anifrolumab was associated with meaningful cost savings while also reducing flare burden supporting the economic value of anifrolumab as a first-line biologic option in SLE treatment.
METHODS: A cohort-based decision model was developed to simulate treatment sequences in patients with SLE eligible for biologic therapy (n=5,858). The model compared sequences starting with SC anifrolumab versus SC belimumab over a 12‑month time horizon, incorporating first and second-line treatment transitions driven by discontinuation rates from Spanish real-world evidence (RWE) studies (RELES and AZAHAR for anifrolumab; BEL-Spain and OBSErve-Spain for belimumab). Flares were included in the model, using rates derived from anifrolumab (Pooled TULIP, TULIP-SC) and belimumab (BLISS-76, BLISS-SC) clinical trials. Direct healthcare costs(€,2026) were estimated from the Spanish National Health System, including pharmacological and flare costs. Outcomes included total costs, cost per patient and cost per responder. Sensitivity analyses explored alternative price assumptions, flare data sources (indirect comparison and RWE), SC/IV treatment distributions compared with the 100%SC base case, and the societal perspective.
RESULTS: Initiating biologic treatment with SC anifrolumab was associated with lower total costs than starting with SC belimumab (€98.7M vs €105.3M), generating savings of €6.7M (−6%), equivalent to €1,136 per patient. The anifrolumab-initiated sequence was also associated with fewer flares (−69%) and had a lower cost per responder (€17,932 vs €19,652), representing a 9% reduction. Sensitivity analyses showed consistent results, with cost savings maintained across alternative assumptions and under the societal perspective.
CONCLUSIONS: A treatment sequence initiated with anifrolumab was associated with meaningful cost savings while also reducing flare burden supporting the economic value of anifrolumab as a first-line biologic option in SLE treatment.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE274
Topic
Economic Evaluation, Health Technology Assessment, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Biologics & Biosimilars, No Additional Disease & Conditions/Specialized Treatment Areas, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)