OBJECTIVES: Canakinumab, a fully human monoclonal antibody targeting interleukin-1β, was recently shown to be beneficial for the secondary prevention of cardiovascular disease (CVD) in the Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS). This study aimed to determine the cost-effectiveness of canakinumab in this setting.

METHODS: A Markov model was developed to simulate the experiences of a hypothetical secondary prevention cohort with elevated high sensitivity C-reactive protein (hsCRP) levels profiled on CANTOS, who were treated with canakinumab or placebo. With each yearly cycle, individuals could have a recurrent non-fatal myocardial infarction or stroke event or die, over a 20-year time horizon. Transition probabilities were based on event rates in CANTOS for the first cycle, and increased according to age-related changes thereafter. Cost and utility data were sourced from the literature. An Australian public healthcare system perspective was applied. All future outcomes (years of life lived, quality-adjusted life years (QALYS) and costs) were discounted by 5% per annum. A secondary analysis of on-treatment hsCRP level at 3 months was undertaken.

RESULTS: Compared to placebo, canakinumab prevented 40 CVD events (16 non-fatal and 24 fatal) in 1000 secondary prevention individuals over 20 years, saving 287 years of life lived and 239 QALYs. Canakinumab would meet Australia’s cost effective threshold of AUD50,000 per QALY gained at an annual acquisition price of AUD1500 (USD1127, EU970, GBP861) per person. With an on-treatment hsCRP level of <2mg/L at 3 months, effectiveness was improved with 1018 years of life saved and 803 QALYs saved. Cost-effectiveness was also improved with an acquisition price of up to AUD4000 (US3005, EU2587, GBP2296) per person.

CONCLUSIONS: Canakinumab is an attractive treatment option to reduce recurrent CVD and would be considered cost-effective to the Australian public healthcare system if its annual costs do not exceed AUD1500 (USD1127, EU970, GBP861) per person.