OBJECTIVES: To evaluate the budget impact of including secukinumab for the treatment of ankylosing spondylitis (AS) patients from the perspective of the Brazilian private healthcare system.

METHODS: A five-year time horizon excel-based Markov model was developed to estimate the investment required for the inclusion of secukinumab in a hypothetical healthcare plan formulary, by comparing two scenarios: "without secukinumab" versus "with secukinumab". The model assumed the following parameters: a hypothetical population of 1,000,000 individuals in the first year and an annual incidence rate equal to 0.007% from the second year on; AS prevalence of 0.12%; from total AS patients, 35% are eligible for biologic therapy and among them 19.4% are treated with discontinuation rate of 30% for all biologic therapies.

Market share of all biologics (adalimumab, certolizumab, etanercept, golimumab, infliximab and secukinumab) were calculated throughout three different assumptions: (A1) In both scenarios, all patients (naïve and biologic-experienced) were distributed equally among all biologics; (A2) Secukinumab as a preferential choice for naïve patients (100%); (A3) Secukinumab as a preferential choice for naïve and biologic-experienced patients who failed to previous biologic treatment (100%).

Only drug costs were considered, which were based on the respective ex-factory prices and the recommended dosages. Infliximab cost was also based on an average body weight of 70kg.

RESULTS: In this hypothetical healthcare plan population, 105 AS patients would be treated with biologic agents at the end of five yearsThe total budget impact, due to the introduction of secukinumab in its formulary, was negative in all three assumptions as follows: (A1) –BRL1,92 million; (A2) –BRL3,08 million and (A3) –BRL6,44 million.

CONCLUSIONS: The introduction of secukinumab in the treatment of ankylosing spondylitis patients could generate savings from the perspective of private healthcare system according to this model, suggesting secukinumab as preferred biologic treatment choice in this market.