Background Golimumab (Gol) has been approved by the Scottish Medicines Consortium in the treatment of adults with severe active non-radiographic axial spondyloarthritis (nr-axSpA) with objective signs of inflammation, as indicated by elevated C-reactive protein and/or magnetic resonance imaging evidence, who have had an inadequate response to or are intolerant to nonsteroidal anti-inflammatory drugs.
Objectives To evaluate the cost-effectiveness (CE) of Golimumab (Gol) in addition to conventional care (CC) in the treatment of nr-axSpA, in Scotland, from an NHS perspective.
Methods We built a Markov model to assess CE in nr-axSpA patients over their lifetimes. Among the treated population, disease progression through 60 weeks was based on the GO-AHEAD trial. Post-week 60, BASDAI/BASFI scores were held constant until week 260, when assumed the disease deterioration rate to be 50% of CC. At week 12, patients were responders if they had a ≥50% improvement from baseline BASDAI scores, otherwise they discontinued. We applied a fixed discontinuation rate, post-week 12. Patients reached equivalent health states to those on CC 24 weeks, post-discontinuation. Utilities were linked to BASDAI/BASFI scores based on trial data. We used a published equation using BASFI scores to estimate long term health care costs. Discounting was applied at 3.5%/year. Uncertainty was explored through sensitivity analyses.
Results The average baseline values for age, BASFI and BASDAI scores (based on GO-AHEAD data) was 31 years, 5.01 and 6.49, respectively. Gol when added to CC, led to an increase of 2.06 QALYs (8.98 vs. 6.92) per patient at an additional net cost of £39,770 (£146,908 vs. £107,138) compared with CC alone. Gol resulted in an incremental cost-effectiveness ratio (ICER) of £19,280/QALY. The ICER was sensitive to the correlation between BASDAI/BASFI and health-care costs and utilities in sensitivity analyses.
Conclusions Gol+CC is cost-effective compared with CC alone for the treatment of nr-axSpA in Scotland.
Disclosure of Interest R. Borse Employee of: Merck & Co., Inc, E. McCann Employee of: Merck & Co., Inc, O. McGill Employee of: Merck & Co., Inc, C. Black Employee of: Merck & Co., Inc, S. Kachroo Employee of: Merck & Co., Inc, R. Insinga Employee of: Merck & Co., Inc