Ixekizumab Superior to Secukinumab in Providing More Quality-Adjusted Life-Years in Psoriatic Arthritis

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Researchers conducted cost-effectiveness analyses to compare ixekizumab and secukinumab in psoriatic arthritis and moderate to severe plaque psoriasis.

Compared with secukinumab, ixekizumab provides more quality-adjusted life-years (QALYs) to patients with psoriatic arthritis (PsA) and concomitant moderate to severe plaque psoriasis at a marginally lower cost, according to study results published in PharmacoEconomics – Open.

In this study, investigators in the United Kingdom conducted cost-effectiveness analyses comparing ixekizumab and secukinumab, 2 interleukin-17A antagonist biologic disease-modifying antirheumatic drugs (bDMARDs) with similar treatment efficacy of PsA. Researchers sought to determine the treatment arm that achieved maximal clinical improvement while minimizing health costs to both patients and the healthcare system.

Using a Markov model, which is based on the York model, the investigators included a hypothetical cohort of adult patients with PsA and concomitant moderate to severe plaque psoriasis and simulated 4 health states, including a bDMARD trial period, continuous therapy, best supportive care, and death, along with 4 treatment options that aligned with UK’s National Health Service (NHS) practice guidelines. The population and characteristics of patients were modeled from data derived from previous intent-to-treat trial populations. Data for each treatment arm were extrapolated from a network of meta-analysis for both therapeutics. Researchers used 2 clinical scoring criteria, including PsA Response Criteria and Psoriasis Area and Severity Index (PASI), to determine response to treatment. Quality of life was assessed using a health assessment questionnaire, and resource cost included treatment cost, physician visit, and medication administration costs, and an algorithm estimating the cost of care depending on the PASI and health assessment questionnaire scores.

Results indicated that ixekizumab vs secukinumab demonstrated slightly lower total costs of care and higher total QALYs in both bDMARD-naive and -experienced patients (£155,455 vs £155,530 and 8.127 vs 7.989, and £140,051 vs £140,264 and 3.996 vs 3.875, respectively). Consistent results were derived from the various sensitivity analyses carried out in this model, which the researchers noted can be adapted to countries with reimbursement and treatment practices different to those in the UK.

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Study limitations included lack of data availability since rheumatoid arthritis data were used for health resource cost estimates instead of PsA data, the use of therapeutic list pricing instead of the confidential preferred price used by the NHS, and the exclusion of data on patient preferences of treatment options.

Researchers concluded, “Although total costs and QALYs were quite similar for ixekizumab and secukinumab, with a modest advantage to ixekizumab for both parameters in bDMARD-naive and -experienced patients with PsA and concomitant moderate to severe psoriasis, we believe the findings of our analysis still provide insights that may be helpful for healthcare decision-makers when allocating resources.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Schweikert B, Malmberg C, Äkerborg Ö, et al. Cost-effectiveness analysis of sequential biologic therapy with ixekizumab versus secukinumab in the treatment of active psoriatic arthritis with concomitant moderate to severe psoriasis in the UK [published online on March 12, 2020]. Pharmacoecon Open. doi:10.1007/s41669-020-00202-1