Analysis of Cost-Effectiveness of Biologic Therapies in Axial Spondyloarthritis Based on Real-World Data

To assess the cost-effectiveness of biologics in patients with axial spondyloarthritis (axSpA) in a real-world setting.

This is a non-interventional, registry-based, prospective cohort study included 203 consecutive patients with axSpA who attended the Rheumatology Department of a public hospital in the Emirate of Dubai between July 2018 and September 2020. Demographic and clinical data were collected and disease activity and treatment response were assessed. Patients were grouped according to the treatment received, distinguishing between biologics and non-biologics, and classified them based on their disease activity at baseline and 52 and 104 weeks. The direct and indirect costs associated with their management were collected. The incremental cost-effectiveness ratio (ICER) was calculated and the impact of patient-related factors on its value across subgroups was examined. A state-transition model was used to simulate disease progression across four health states over a lifetime (62 years), and Monte Carlo simulation was applied to address uncertainty.

The total cost of managing the patients was AED 27,532,189, resulting in a gain of 293.7 quality-adjusted life years (QALYs) over a 2-year follow-up period. Biological therapies were associated with higher direct costs, accounting for 83.3% of the total costs of biologics. The overall ICER was AED 253,616 per QALY, influenced by higher medication acquisition costs. Patients with < 5 years of disease duration, female patients, those with radiographic-axSpA, co-existing fibromyalgia, and those receiving a combination of biologic treatments and conventional disease-modifying antirheumatic drugs showed a higher ICER than the median ICER of all biologic therapies.

Biologic therapies are cost-effective for patients with axSpA, especially those not achieving clinical targets. Patients' selection, and targeted cost-containment strategies, such as biosimilars and medication price reductions, can enhance clinical benefits and reduce societal costs.