Budget Impact of Secukinumab in Psoriatic Arthritis Patients with Contraindication to TNF-Alpha Inhibitors

Secukinumab, an IL-17A inhibitor, has been recommended for psoriatic arthritis (PsA) patients with contraindications to TNF-alpha inhibitors (TNFi). However, its budgetary implications in Thailand remain unclear.

To estimate the 5-year budget impact of introducing secukinumab 150 mg for PsA patients contraindicated to TNFi therapy from the perspective of the Thai healthcare system.

A budget impact analysis (BIA) was developed following the Thai HTA Guideline. Two treatment scenarios were compared: the current standard of care using csDMARDs and a new scenario incorporating secukinumab 150 mg (auto-injector). The model estimated eligible patients based on national demographics and clinical data. Costs included direct medical costs for medications, administration, monitoring, and complications. Net budget impact (NBI) was estimated. Deterministic sensitivity analyses were conducted to evaluate the impact of varying uptake rates and treatment durations.

Under the base-case scenario over five years, secukinumab use resulted in the NBI of 15.14 million THB (434,965 USD), with an average annual net budget impact of 3.03 million THB (86,993 USD). Drug acquisition accounted for 97.16% of the total budget impact. Sensitivity analyses revealed a higher financial burden with increased uptake or lifetime treatment but remained within a manageable range (up to 18.34 million THB or 526,849 USD).

Introducing secukinumab for PsA patients contraindicated to TNFi is associated with a moderate increase in healthcare expenditure. These findings suggest that inclusion of secukinumab in the National List of Essential Medicines for this specific population may be feasible, conditional on successful price negotiation and/or managed entry arrangements to ensure budgetary sustainability and equitable access.