BACKGROUND: Tildrakizumab, a high-affinity, humanized, IgG1κ, anti-interleukin–23 monoclonal antibody, was recently approved in the U.S. to treat moderate-to-severe plaque psoriasis on the basis of two placebo-controlled, phase 3 studies with over 1,800 patients. This analysis examines tildrakizumab's cost-effectiveness.
OBJECTIVES: To evaluate the cost-effectiveness of tildrakizumab compared with adalimumab, apremilast, brodalumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab used as first-line therapy for patients with moderate-to-severe psoriasis from a U.S. health plan’s perspective.
METHODS: A 10-year Markov model, consisting of health states based on Psoriasis Area Severity Index (PASI) response rate categories (PASI 0-49, PASI 50-74, PASI 75-89, PASI 90-100) and death, was developed. Patients received one of the treatments upon entry into the model. Nonresponders (patients with less than PASI 75 response) discontinued their current treatment, with 25% receiving topical therapy, phototherapy, or other systemic therapy until the end of the 10 years or death and the remaining 75% receiving a basket of the other comparators as a second-line therapy before receiving topical therapy, phototherapy, or other systemic therapy The probabilities of achieving PASI responses were derived from a network meta-analysis based on published clinical trial data. Health care costs consisted of drug acquisition and administration, laboratory tests, and clinical visits. PASI response categories were used to estimate each patient’s quality-adjusted life-years (QALYs).
RESULTS: Over 10 years, the incremental cost per QALY compared with topical therapy, phototherapy, or other systemic therapy was $168,285 for brodalumab, $179,785 for infliximab, $221,214 for apremilast, $237,025 for tildrakizumab, $238,539 for secukinumab, $258,084 for guselkumab, $260,574 for ixekizumab, $266,374 for adalimumab, $267,307 for ustekinumab, and $292,273 for etanercept. The position of tildrakizumab relative to the other treatments remained the same across multiple scenarios.
CONCLUSIONS: First-line treatment with tildrakizumab is among the more cost-effective options and is more cost-effective than treatment with guselkumab, secukinumab, ixekizumab, ustekinumab, adalimumab, or etanercept.
