OBJECTIVES: In treating psoriasis, switching between biologic treatments occurs frequently. A cost-effectiveness model was adapted to assess the impact of placing secukinumab (SEC), an anti-IL-17A antibody, in treatment sequencing with other biologics: adalimumab (ADA), etanercept (ETN), infliximab (INF), and ustekinumab (UST) in eligible psoriasis patients.
METHODS: A decision-tree model reflecting response to treatment (defined as Psoriasis Area Severity Index Reduction by ≥ 75% [PASI75] or ≥ 90% [PASI90]) led into a Markov model with health states related to treatment continuation, drop-out and death. Responders at week 16 continued on biologic treatment. Non-responders switched to another biologic in second- and third-line biologic treatment. A 2-year German payer perspective was adopted. Clinical data inputs were derived from a mixed treatment comparison; resource unit costs from national sources; EQ-5D utilities from SEC clinical trials; adverse events and discontinuation rates from published literature. All possible biologic treatment sequences were analyzed, with SEC as first-, second-, or third-line biologic, and probabilistic sensitivity analyses conducted.
RESULTS: Estimated ‘cost per PASI90 responder’ were lowest and ‘time in PASI90’ was longest with SEC as first biologic. Cost per PASI75 responder results were comparable. The three-line treatment sequence of SEC-ADA-UST had the lowest estimated cost per PASI90 responder compared with any other combination of biologics, or with SEC in second- or third-line biologic therapy. With SEC as first biologic, mean time in PASI90 was 19.9% longer than with SEC as second-line biologic treatment and 36.8% longer than with SEC as third-line biologic. Probabilistic sensitivity analyses showed similar results.
CONCLUSIONS: Treatment of psoriasis with SEC as first biologic treatment is cost-effective from a German payer perspective, compared with initiating other biologic therapy. Results are based on list prices; any potential price change during current negotiations with the National Association of Statutory Health Insurance Funds may result in more favourable cost-effectiveness results of SEC.
