BACKGROUND: Tildrakizumab, an anti-interleukin–23 monoclonal antibody, was approved in the US for patients with moderate-to-severe plaque psoriasis. Many biologics and apremilast are widely used to treat psoriasis. Understanding the comparative cost-effectiveness and affordability of these treatments is important for health care payers and prescribers.
OBJECTIVE: To evaluate the comparative cost per month with a Psoriasis Area Severity Index (PASI) 75 response and the budget impact of introducing tildrakizumab as first-line treatment for moderate-to-severe plaque psoriasis from a US health plan’s perspective.
METHODS: A Markov model with 5 health states (PASI 0-49, 50-74, 75-89, 90-100; death) was developed to assess the incremental cost per month with a PASI ³75 response for each first-line treatment compared with a mix of topical therapy, phototherapy, or other systemic therapy. Responders (PASI ³75) maintained current treatment. Non-responders received either a mix of topical therapy, phototherapy, other systemic therapy, or a second-line therapy. The budget impact of introducing tildrakizumab was estimated for a hypothetical US health plan with 1 million members over 5 years, with 1% annual uptake of tildrakizumab. Incremental annual health plan and per-member-per-year (PMPY) costs were estimated. Data from published literature, clinical trials, and prescription data were used for model inputs; 2019 drug costs were used. Adalimumab, apremilast, brodalumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab were included in both models.
RESULTS: The incremental costs per month with a PASI ³75 response were: brodalumab, $3,559; infliximab, $3,762; apremilast, $4,621; tildrakizumab, $4,895; secukinumab, $5,522; guselkumab, $5,712; adalimumab, $5,754; ixekizumab, $5,764; ustekinumab, $5,916; and etanercept, $6,180. Tildrakizumab had lower annual costs than etanercept, adalimumab, secukinumab, ixekizumab, guselkumab, or ustekinumab. For a health plan of 1 million members with 1,048 patients receiving biologics or apremilast, introducing tildrakizumab resulted in a 5-year cumulative reduction of $964,763 in health plan costs and $0.19 in PMPY costs.
CONCLUSIONS: Tildrakizumab as a first-line treatment is among the most cost-effective therapies for psoriasis, and is more cost effective than secukinumab, guselkumab, adalimumab, ixekizumab, ustekinumab, or etanercept. Introduction of tildrakizumab has the potential to reduce the overall costs of psoriasis treatment for a US health plan.
