Cost-Effectiveness of Golimumab in Ankylosing Spondylitis from the UK Payer Perspective

Golimumab is a tumor necrosis factor-alpha (TNF-alpha) inhibitor for treatment of patients with severe, active ankylosing spondylitis. This study evaluated the cost-effectiveness of golimumab compared with conventional care and other TNF-alpha inhibitors in treatment of AS from the UK National Health Service perspective. A long-term Markov model (with initial decision tree) was developed to simulate the progression of a hypothetical cohort of patients with active AS over a lifetime. The effectiveness outcome was quality-adjusted life-years (QALYs). Utilities were estimated by mapping Bath Ankylosing Spondylitis Functional Index scores, and the primary response measure was ae<yen>50% improvement on the Bath Ankylosing Spondylitis Disease Activity Index at 12 weeks. Direct, medication, and AS management costs were included. Costs and outcomes were discounted at 3.5%. All TNF-alpha inhibitors were comparable to each other and superior to conventional care. The incremental cost-effectiveness ratios (ICERs) for TNF-alpha inhibitors were A 19,070-42,532 pound per QALY gained compared with conventional care. Analyses of the ICERs for each TNF-alpha inhibitor compared with conventional care demonstrated that golimumab was the most cost-effective treatment, and that adalimumab and etanercept were dominated by golimumab. Sensitivity analyses confirmed the robustness of these analyses. Golimumab may be considered a cost-effective treatment alternative for patients with active AS. With comparable costs and efficacy among TNF-alpha inhibitors, the choice of TNF-alpha inhibitor to treat AS is likely to be driven by patient and physician choice. Merck & Co., Inc.