OBJECTIVES: To evaluate the cost-effectiveness of secukinumab compared to available biologic treatments including certolizumab-pegol, etanercept, adalimumab and infliximab, in the treatment of active ankylosing spondylitis (AS) unresponsive to conventional treatment.

METHODS: A Markov model representing the transition of active AS patients unresponsive to conventional treatment from current health state towards responder state (BASDAI-50 response) was adapted to the Turkish setting. The time horizon was set as life-time. Clinical inputs were derived from a Bayesian fixed effects network meta-analysis, covering the clinical trials of all treatment options. Utility values were based on international literature. The analysis was undertaken from payer’s perspective. Only direct costs were taken into account. Local costs of medications, administration and monitoring were converted based on TL/EUR currency rate of 3.7166 at end-2016. Incremental cost effectiveness ratio (ICER) per gained time spent in BASDAI-50 responder state and also per quality-adjusted-life-years (QALY) gained were calculated.

RESULTS: All analyses were performed in biologic-naïve and biologic-experienced AS patients, as well as a mixed group. In biologic-naïve patients, total cost of secukinumab was found to be 4,644-9,134EUR lower than others. Gained time spent in BASDAI-50 responder state was 0.14-2.13 years with secukinumab. Furthermore, QALY gained with secukinumab was calculated as 0.20-0.86QALY. Cost-saving with secukinumab ranged between 7,641-15,297EUR, in biologic-experienced group. On the other hand, time spent in BASDAI-50 responder state was 0.21-2.05 years longer than others and QALY gained ranged between 0.26-1.06QALYs. In mixed group, total cost of secukinumab option was found to be 7,270-11,640EUR lower than others. Gained time spent in BASDAI-50 responder state was 0.21-2.05 years with secukinumab. Furthermore, QALY gained with secukinumab was calculated as 0.24-0.96QALY.

CONCLUSIONS: Given its significant improvement in clinical response and quality-of-life and dominance, secukinumab is strongly suggested to be more effective and cost-saving in active AS patients unresponsive to conventional treatment in Turkey.