Presentation (CTI)

OBJECTIVES: Ankylosing spondylitis is a debilitating chronic inflammatory disease that affects the spine and joints, initially treated with conventional anti-inflammatory drugs and, in case of therapeutic failure, with multiple lines of advanced therapies (AT). Aiming to measure the efficiency of AT available in Brazil, this study calculated the cost per responder (CPR) to achieve at least a 40% improvement in the Assessment of Spondyloarthritis International Society (ASAS 40) based on a published network meta-analysis (NMA) using local list prices from the perspective of private health system (Walsh et al, 2023).
METHODS: The CPR calculation is the total cost of treatment of each AT divided by its respective response rate from the referred NMA, representing the cost required for one patient to achieve ASAS 40, therefore, the lower the CPR, the more efficient the treatment is. The cost of treatment was estimated with label posology and list prices plus tax rate of 18%. The results were stratified by CF (conventional treatment failure) and BF (biological treatment failure) populations.
RESULTS: Considering CF, upadacitinib 15 mg was the AT with lower CPR, R$ 133.951,79. Comparatively, golimumab 50 mg had a 50% higher CPR, secukinumab 150 mg 30%, ixekizumab 80 mg 41%, tofacitinib 5 mg 56%, secukinumab 300 mg 80%, golimumab 100 mg 111%, etanercept 25/50 mg 133% and adalimumab 40 mg 184%. In BF population, upadacitinib 15 mg was associated with lower CPR too, R$ 181.767,49. Versus this AT, secukinumab 300 mg, secukinumab 150 mg, tofacitinib 5 mg and ixekizumab 80 mg demand higher financial investment to achieve the same outcome: 70%, 72%, 94% and 120% higher CPRs, respectively.
CONCLUSIONS: upadacitinib represented a lower CPR versus all other AT in both populations. This metric provides a method to assess the efficiency of therapeutic strategies, so these findings suggest that upadacitinib would improve the care of spondyloarthritis patients.