OBJECTIVES: To evaluate the cost-effectiveness of upadacitinib in patients with active non-radiographic axial spondyloarthritis (nr-axSpA), who have responded inadequately to conventional treatment (NSAIDs), in Greece.

METHODS: A cost-effectiveness model, consisted of a 12-week decision tree model (induction period) and a long-term Markov state-transition model with a 12-week cycle length (maintenance period), was locally adapted from a public payer perspective. Upadacitinib was primarily compared to adalimumab, the most utilized biological therapy for the treatment of nr-axSpA in Greece (usual care). Response to treatment was defined as at least 50% improvement from baseline in BASDAI (BASDAI50) at the end of the initial-induction phase, obtained from a network meta-analysis. Non-responders moved to conventional care. Long-term treatment withdrawal and changes in BASFI as well as utility values were retrieved from published literature. Direct costs pertaining to drug acquisition, administration, monitoring, disease management, and adverse events were considered in the analysis. All cost inputs were indexed to 2023 euros. The incremental cost effectiveness ratio (ICER) per a quality-adjusted life-year (QALY) gained was used as assessment tool. Sensitivity and scenario analyses were performed to ascertain the robustness of the base-case findings.

RESULTS: Over a patient’s lifetime, compared to adalimumab, upadacitinib was found to be more effective (0.371 incremental QALY gains) and less costly (€89 cost-savings) representing a dominant therapeutic option. One-way sensitivity and scenario analyses confirmed the cost-effective profile of upadacitinib. Scenario analyses with other relevant comparators such as etanercept, secukinumab, and ixekizumab also corroborated the cost-effective profile of upadacitinib (€12,253, €19,234, and dominant respectively). At the defined cost-effectiveness threshold of €42,000/QALY gained (twice the Greek per capita income), probabilistic sensitivity analysis showed that upadacitinib had a 76% probability of being cost-effective relative to adalimumab.

CONCLUSIONS: Upadacitinib, the first oral advanced therapy for the treatment of nr-axSpA, was estimated to be a cost-effective therapy in its new indication in Greece.