Pharmacoeconomic studies on biologic agents for ankylosing spondylitis: A systematic review

Abstract

Objective: This study aims to systematically review and assess the quality of published pharmacoeconomic studies on biologic

agents for ankylosing spondylitis conducted both domestically and internationally.

Methods: PubMed, Embase, and the Cochrane Library databases were searched using English keywords such as “ankylosing

spondylitis” and “pharmacoeconomics.” Chinese databases, including China National Knowledge Infrastructure (CNKI) and

Wanfang Database, were searched using Chinese keywords such as “ankylosing spondylitis”, “cost” and “effectiveness”. The

search was conducted from the inception of the databases until February 2023. The quality of the included studies was assessed

using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) and the Quality of Health Economics

Studies Instrument (QHES). Two researchers extracted data from the included studies, and descriptive analysis was performed

to summarize the characteristics of the included studies.

Results: A total of 24 English-language studies were included in the review. The included studies were published between 2004

and 2020, with 19 studies classified as high-quality and 5 studies as “general quality studies.” Furthermore, 18 studies (75%) were

model-based pharmacoeconomic evaluations, including Markov models, mathematical models, and discrete event simulation

models. In terms of economic evaluations, Tumour necrosis factor (TNF) inhibitors and IL-17 inhibitors were found to be more

cost-effective compared to traditional nonsteroidal anti-inflammatory drug (NSAIDs) treatment. Factors such as the BASDAI 50

response rate and disease-related costs had varying degrees of impact on the incremental cost-effectiveness analysis results.

Conclusion: The overall results indicate that, in the short-term treatment scenario, biologic agents are not cost-effective

compared to traditional treatment options, but in the long-term treatment scenario, biologic agent treatment becomes more

cost-effective. The most cost-effective intervention measures varied among different studies comparing different biologic agents.

Key words: ankylosing spondylitis, biologicals, pharmacoeconomic evaluation, systematic review, TNFis inhibitors, IL-17 inhibitor