Assessing the Value of Bimekizumab for TNF-alpha Inhibitor-Experienced Patients with Psoriatic Arthritis: A Cost-Effectiveness Approach
Open Access
- Author:
- Deihl, Derek
- Area of Honors:
- Interdisciplinary in Finance and Economics
- Degree:
- Bachelor of Science
- Document Type:
- Thesis
- Thesis Supervisors:
- David J Vanness, Thesis Supervisor
Brian Spangler Davis, Thesis Honors Advisor
Conor Ryan, Thesis Supervisor
Nima Haghpanah, Thesis Honors Advisor
Bee Yan Roberts, Faculty Reader - Keywords:
- Health Economics
Cost Effectiveness Analysis
Pharmaceutical
Psoriatic Arthritis
Value Based Pricing
Medicare
Inflation Reduction Act
Institute for Clinical and Economic Review (ICER)
Bimekizumab
Bimzelx - Abstract:
- This thesis intends to analyze the cost-effectiveness of bimekizumab (BKZ) against competing disease-modifying antirheumatic drugs (DMARDs) for psoriatic arthritis (PsA) from the United States healthcare sector perspective. Modeled after Swedish research published by Sigurdardottir et al. (2023), this thesis constructs a Markov model to simulate the clinical pathway of tumor necrosis factor alpha experienced (TNF-alpha exp) patients over a lifetime horizon of 50 years. The model incorporates treatment response as measured by American College of Rheumatology 50% (ACR50) for joints and Psoriasis Area and Severity Index ##% (PASI##) for skin in addition to changes in the Health Assessment Questionnaire Disability Index (HAQ-DI) score of overall health. Patients remain on treatment by achieving ACR50 and at least PASI75 and will return to best supportive care of concomitant methotrexate if failing to meet these thresholds. Efficacy parameters were derived from Sigurdardottir et al. (2023) stemming from the bimekizumab clinical trial “BE COMPLETE” (Merola et al., 2023) and a network meta-analysis of comparators (Mease et al., 2024). Drug costs and healthcare resource use were derived from the Department of Veterans’ Affairs Federal Supply Schedule (FSS), Centers for Medicare and Medicaid (CMS) Part B claims data, and indirect HAQ-DI costs modeled after Ogdie et al. (2022). An opportunity cost of $100,000 per QALY (Vanness et al., 2023) was used as the base case threshold of willingness-to-pay, and $200,000 per quality-adjusted life year (QALY) was applied as a sensitivity analysis. Bimekizumab was not on the cost-effectiveness frontier as it was extended dominated – more costly and less effective than a convex combination of treatments using certolizumab pegol and upadacitinib. From the FSS, the average BKZ contract price per pack (2 doses) is $10,779.02. At the $100,000/QALY ICER threshold, the contract price should be nearly halved to $5,872.87. This model makes strong assumptions regarding the clinical pathway of patients which limits the reliability of this analysis; however, it reflects a key perspective outlined by the Institute for Clinical and Economic Review (ICER) on the Inflation Reduction Act CMS Medicare drug price negotiation process.