Assessment of the economic impacts of ankylosing spondylitis associated pain reduction using adalimumab (Humira)

Ankylosing spondylitis (AS) is a chronic, progressive, inflammatory rheumatic disease that primarily affects the axial skeleton [1]. This mostly affects working age population, with the onset of disease at around 26 years [2] and affects more men than women [2, 3]. AS significantly impacts patients quality of life [4] and limits their ability to perform daily activities including performing paid and unpaid work [5]. Several studies have reported the effects of AS on patients’ ability to work [6-13] including a large cross-sectional study of Dutch patients which found that the labour force participation was decreased by 15.4% in male patients and 5.2% in female patients with AS compared to the general Dutch population [6]. Since the onset and progression of AS mainly occurs during the stage of an individual’s life when they are more likely to be working and producing income, the economic burden of patients’ staying out of the labour force due to AS is substantial.
Adalimumab (trade name: Humira) is one of the Tumor-Necrosis-Factor alpha (TNF-α) blockers available for the treatment of AS, with etanercept (trade name: Enbrel), infliximab (trade name: Remicade), golimumab (trade name: Simponi) and certolizumab pegol (trade name: Cimzia) being the others [1, 14-16]. A placebo-controlled randomised controlled trial of adalimumab for patients with AS found that adalimumab is safe and clinically effective for the treatment of patients with AS and is well tolerated by the patients [17]. The trial also provided evidence of improved health related quality of life [18] and reduced pain and fatigue [19] with the use of adalimumab in patients with AS. The long-term outcomes of adalimumab on patients with AS have also been reported as positive [20, 21]. Furthermore, a cost-effectiveness analysis of adalimumab for the management of AS based on the National Institute for Clinical Excellence (NICE) guidelines found that it is cost-effective for the treatment of patients with AS [22]. Adalimumab received regulatory approval for the treatment of AS in Australia and is listed in the Australian Pharmaceutical Benefit Scheme (PBS) in 2006 [23].