This economic evaluation compared the cost-efficiency of three approved monoclonal antibody therapies for moderate-to-severe hidradenitis suppurativa (HS) — adalimumab, secukinumab, and bimekizumab — across five countries (US, Canada, France, Germany, Australia) using Phase 3 trial efficacy data and publicly available drug pricing as of January 31, 2026.
Adalimumab 40 mg weekly was on the efficiency frontier in all five countries for both HiSCR-50 and HiSCR-75 outcomes. Secukinumab 300 mg every 4 weeks reached the frontier only when US wholesale acquisition costs were used. Annual costs ranged from $11,345 (adalimumab in Australia) to $411,990 (bimekizumab in the US).
- Only publicly available list prices were used; negotiated or rebated prices, which vary widely, were not included. - Efficacy data were drawn from separate Phase 3 trials without head-to-head comparisons, limiting direct cross-drug efficacy inference. - Full-text access was unavailable; some methodological details may be incomplete.
Adalimumab remains the most cost-efficient approved biologic for HS across major health systems, with costs up to 36-fold lower than bimekizumab in the US. Clinicians and payers advocating for value-based formulary decisions should weigh these large pricing differentials alongside efficacy data.
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