OBJECTIVES: Secukinumab (SEC) 300 mg, a fully human interleukin-17A antibody, has demonstrated superior and sustained efficacy in adults with moderate to severe psoriasis compared with ustekinumab (UST), etanercept (ETN), and placebo. This analysis compared the cost per responder of SEC as first biologic treatment with adalimumab (ADA), infliximab (INF), ETN, and UST.
METHODS: A 52-week decision tree, reflecting response to treatment (defined as Psoriasis Area Severity Index [PASI] reduction of < 50%, 50-74, 75-89, and = 90 [“PASI=90”]), led into a Markov model with health states related to treatment continuation, drop-out, and death. Responders (i.e., PASI=75 and PASI=90) at week 16 continued initial treatment. Sustained response was defined as 16-week response maintained at week 52. Nonresponders and drop-outs were switched to standard of care. A 10-year German health care system perspective with 3% discount rates was adopted. Clinical data came from a mixed-treatment comparison; 2016 resource unit costs from national sources; and adverse events and discontinuation rates from literature. We calculated cost per PASI=90 responder over week 16 and over week 52, as well as per sustained responder between weeks 16 and 52. Sensitivity analysis, excluding co-pays, was conducted.
RESULTS: SEC had the lowest cost per PASI=90 responder over 16 weeks (€17,907) compared with UST (€18,027), ADA (€23,418), INF (€28,416), or ETN (€33,939). Over 52 weeks, costs per PASI=90 responder ranged from €42,078 (SEC) to €69,968 (ETN). Likewise, SEC had the lowest cost per sustained 52- week PASI=90 responder (€22,514) and UST the highest (€31,107). SEC dominated all other biologics on the costeffectiveness frontier. Sensitivity analysis supported robustness of results.
CONCLUSIONS: SEC treatment of moderate to severe psoriasis is cost-effective, reducing cost per responder compared with other biologic treatments over 10 years in Germany.
