OBJECTIVES: To estimate the cost per Psoriasis Area and Severity Index (PASI) ≥90 responder of secukinumab as first biologic treatment compared with adalimumab, etanercept, infliximab and ustekinumab over 16 and 52 weeks, and cost per sustained response in 16-week responders up to 52 weeks from the perspective of the Brazilian private healthcare system.
METHODS: A 52-week decision-tree model reflecting response to treatment, defined as PASI reduction of <50%, 50%-74%, 75%-89% and ≥90% was developed. Non-responders patients (PASI<75 at 16 weeks) and patients that discontinued treatment due to other reasons (e.g. adverse events, dropouts) were switched to standard of care. Clinical data inputs of PASI distribution at 4, 8, 12, 16 and 52 weeks were derived from a mixed treatment comparison comparing the biologics to placebo. Annual drug costs were based on the respective ex-factory prices and the number of doses required for 52 weeks. Sensitivity analysis was performed to evaluate the uncertainties of the model.
RESULTS: Over 16 weeks, the cost per PASI ≥90 responder of secukinumab (BRL 65,353) was lower than most biologics, except for ustekinumab (BRL 56,638). Secukinumab had the lowest cost per PASI ≥90 responder over 52 weeks (BRL 151,415) compared with ustekinumab (BRL 156,744), adalimumab (BRL 248,203), infliximab (BRL 255,713) and etanercept (BRL 278,183). Likewise, secukinumab had the lowest cost per sustained 52-week PASI ≥90 responder (BRL 82,535) compared with other biologic treatments (range from BRL 98,643 to BRL 136,026). Sensitivity analysis confirmed the favorable results of secukinumab.
CONCLUSIONS: Secukinumab as first biologic treatment of adults with moderate-to-severe psoriasis is cost-effective, with a lower cost per PASI ≥90 responder compared with other biologic treatments in Brazil from private payer perspective.
