Approved Monoclonal Antibody Therapies for Hidradenitis Suppurativa.

Abstract

Importance: Biologic therapies are increasingly used for moderate to severe hidradenitis suppurativa (HS), yet their high cost presents challenges for health systems and payers. Comparative economic evaluations of these therapies are limited.

Objective: To evaluate the efficiency frontier of approved monoclonal antibody therapies for HS across multiple countries.

Design and setting: This economic evaluation used publicly available clinical trial data and drug pricing data. Phase 3 trial efficacy data for adalimumab, secukinumab, and bimekizumab from 6 trials were combined with drug price data from the US, Canada, France, Germany, and Australia as of January 31, 2026. Data analysis was conducted between March 15 and May 22, 2026.

Main outcomes and measures: Efficiency frontier analysis using Hidradenitis Suppurativa Clinical Response (HiSCR) 50 (indicating 50% reduction from baseline) and HiSCR-75 (indicating 75% reduction from baseline) metrics. Incremental cost-effectiveness ratios were calculated where multiple agents lay on the frontier.

Results: Across all examined countries, adalimumab, 40 mg, weekly, consistently was on the efficiency frontier for both HiSCR-50 and HiSCR-75 outcomes. Secukinumab, 300 mg, every 4 weeks, appeared on the frontier only when US wholesale acquisition costs were used. Annual therapy costs ranged from $11 345 for adalimumab, 40 mg, weekly in Australia to $411 990 for bimekizumab, 320 mg, every 2 weeks in the US. Analyses using cost-efficiency estimates adjusted for baseline disease severity showed an efficiency frontier composition similar to unadjusted analyses.

Conclusions and relevance: In this study, among currently approved monoclonal antibody therapies for HS, adalimumab showed dominant cost-efficiency performance across multiple health systems. These findings highlight substantial international variation in biologic drug pricing and provide a framework for value-based pricing in HS therapeutics.