OBJECTIVES : To estimate the cost-effectiveness of secukinumab compared with other available biologic therapies in the treatment of active ankylosing spondylitis (AS), under the Brazilian Unified Health System (SUS) perspective.

METHODS : A semi-Markov decision-analytic model was adapted to the Brazilian setting to evaluate the cost-effectiveness of secukinumab compared with adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab biosimilar in a biologic-naïve population and a mixed population of biologic-naïve and experienced patients, over a 40-year time horizon (lifetime). Efficacy inputs, including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50 response rate and changes in BASDAI and Bath Ankylosing Spondylitis Functional Index (BASFI), were taken from a Bayesian network meta-analysis (NMA), while other model inputs were obtained from published literature. Costs (BRL) included drugs, relevant adverse effects and medical resources estimated from 2019 and benefits were expressed as quality-adjusted life-years (QALYs). Discount rate of 5% for costs and benefits were used and univariate and probabilistic sensitivity analyses (PSA) were performed to evaluate the robustness of the model.

RESULTS : In the biologic-naïve population, secukinumab was the dominant therapy, having the lowest cost (BRL 89,355) and the highest benefit (8.23 QALYs) among all biologic drugs (costs ranging from BRL 89,440 to BRL 135,551 and benefits ranging from 7.43 to 8.16 QALYs). In the mixed population, secukinumab was dominant over all other biologic drugs, except when compared with etanercept, with secukinumab presenting higher costs and higher benefits (costs: BRL 88,968 vs BRL 88,438, benefits: 8.09 QALYs vs 7.38 QALYs) but, nonetheless, associated with a low incremental cost-effectiveness ratio (ICER = BRL 746/QALY). Sensitivity analysis confirmed the favorable results of base case analysis, with secukinumab having the highest probability of being cost-effective in the PSA.

CONCLUSIONS : Secukinumab is the most cost-effective alternative when compared with other biologic agents for patients with AS in Brazil.