OBJECTIVES: Secukinumab (SEC) 300 mg, a fully human interleukin-17A antibody, has demonstrated sustained superior efficacy over ustekinumab (UST) 45/90 mg, an anti-interleukin-12/23 antibody, through 52 weeks in adults with moderate-to-severe psoriasis. This analysis compared the cost per responder of SEC versus UST over 1 year from a German payer perspective.
METHODS: A 52-week decision-tree model reflecting response to treatment, defined as Psoriasis Area Severity Index (PASI)-reduction of < 50, 50-74, 75-89, and = 90% from the CLEAR head-to-head study comparing SEC to UST, evaluated cost per responder (PASI75, PASI90, and PASI100). Responders at week 16 continued initial treatment. Nonresponders and drop-outs were switched to standard of care. Resource unit costs for 2016 were derived from national sources; adverse events and discontinuation rates, from published literature. No discount was applied. Analyses were conducted for responders over week 16 and over week 52, as well as for those with sustained response between weeks 16 and 52. Deterministic sensitivity analyses were conducted to evaluate the impact of drug costs only.
RESULTS: Estimated cost per PASI90 responder was lower for SEC than for UST over 16 weeks (SEC: €15,648; UST: €16,645), over 52 weeks (SEC: €35,668; UST: €49,280), and for 52-week sustained response (SEC: €19,017; UST: €23,800). Overall, PASI75 and PASI100 results also were lower for SEC than for UST. Time in PASI90-99 or PASI100 was longer with SEC than with UST (0.31 vs. 0.24 years and 0.40 vs. 0.20 years, respectively). Sensitivity analyses confirmed the robustness of results: cost per responder remained lower for SEC than for UST.
CONCLUSIONS: The strong and sustained efficacy of SEC compared to UST in the treatment of moderate to severe psoriasis reduces the cost per responder over 1 year in Germany.
