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Biologic Strategies for Ankylosing Spondylitis Not Cost-Effective at Common Threshold

December 07, 2020

No biologic strategies in treatment guidelines for ankylosing spondylitis were cost-effective at a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY), according to a study published in the Journal of Managed Care & Specialty Pharmacy. 

“Nevertheless,” researchers wrote, “the sequential treatment with one tumor necrosis factor (TNF) inhibitor followed by an anti-interleukin-17A monoclonal antibody (IL-17A) agent was considered cost-effective at a higher willingness-to-pay threshold of $150,000 per QALY.” 

The cost-effectiveness study took a US health care payer’s perspective over a 10-year time horizon and 100,000 simulated patients for each treatment strategy. Five strategies were modeled: (1) conventional care treatment with nonsteroidal anti-inflammatory drugs, (2) one TNF inhibitor, (3) an IL-17A antibody agent, (4) sequential therapy with two TNF inhibitors, and (5) sequential therapy with a TNF inhibitor followed by an IL-17A antibody agent. 

The study found average total discounted per-patient costs of $19,765 and 4.675 QALYs for conventional care; $130,302 and 5.410 QALYs for one TNF inhibitor; $159,934 and 5.499 QALYs for an IL-17A antibody agent; $190,553 and 5.919 QALYs for sequential therapy with two TNF inhibitors; and $179,118 and 5.893 QALYs for sequential therapy with a TNF inhibitor followed by an IL-17A antibody agent. 

“The optimal treatments at willingness-to-pay thresholds ≤ $130,813 per QALY, between $130,813 per QALY and $442,728 per QALY, and > $442,728 per QALY were conventional care and sequential treatment strategies with one TNF inhibitor, followed by an IL-17A agent and two TNF inhibitors, respectively,” researchers reported. 

Jolynn Tumolo 


Le QA, Kang JH, Lee S, Delevry D. Cost-Effectiveness of Treatment Strategies with Biologics in Accordance with Treatment Guidelines for Ankylosing Spondylitis: A Patient-Level Model. J Manag Care Spec Pharm. 2020;26(10):1219-1231. doi:10.18553/jmcp.2020.26.10.1219

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