The budget impact of brodalumab for the treatment of moderate-to-severe plaque psoriasis on US commercial health plans

Abstract

Introduction: Brodalumab is a new biologic approved by the US Food and Drug Administration in 2017 for the treatment of moderate-severe psoriasis. This study evaluated the impact of the introduction of brodalumab on the pharmacy budget on US commercial health plans.

Methods: An Excel-based health economic decision analytic model with a US health plan perspective was developed. The model incorporated published moderate-to-severe psoriasis prevalence data; market shares of common biologic drugs, including adalimumab, ustekinumab, secukinumab, ixekizumab, and etanercept, used for the treatment of moderate–severe psoriasis; 2017-year Wholesale Acquisition Costs for the biologic drugs; drug dispensing fee; patient co-pay; and drug contracting discount. Total annual health plan costs for the biologic drugs were estimated. Scenarios with different proportions of patients treated with brodalumab were compared to a control scenario when no brodalumab was used.

Results: In a hypothetical commercial health plan covering two million members, 7,038 moderate-to-severe psoriasis patients were estimated to be eligible for treatment with brodalumab. Prior to brodalumab approval, the proportions of patients treated by other biologics were estimated at 50.8% for adalimumab, 13.5% for ustekinumab, 14.1% for secukinumab, 4.4% for ixekizumab, and 17.2% for etanercept. With a 20% drug price discount applied to all biologics, the annual health plan costs for brodalumab, adalimumab, ustekinumab, secukinumab, ixekizumab, and etanercept were estimated at $37,224, $49,166, $55,084, $56,061, $64,396, and $57,170, respectively. When no brodalumab is used, the total annual pharmacy budget for the biologics used among these patients was estimated at $414,362,647. Among scenarios where the proportions of brodalumab usage were 3%, 8%, 16%, and 30%, the total annual pharmacy cost was estimated to be reduced by $3,698,129, $9,861,677, $19,723,355, and $36,981,290, respectively.

Conclusion: Based on the economic model, brodalumab has the potential to substantially reduce pharmacy expenditures for the treatment of patients with moderate-to-severe plaque psoriasis in the US.

Keywords:

• Biologic drugs
• brodalumab
• cost-analysis
• moderate-to-severe plaque psoriasis

Transparency

Declaration of funding

This research was supported by Ortho Dermatologics.

Declaration of financial/other relationships

JJW is an investigator for AbbVie, Amgen, Eli Lilly, Janssen, Novartis, and Regeneron. SRF served as a consultant for Ortho Dermatologics for conducting this study. SR is an employee of Ortho Dermatologics. BM, MLS, and JL are employees of Novosys Health, which has received research funds from Ortho Dermatologics for conducting this study and development of this manuscript. Peer reviewers on this manuscript have received an honorarium from JME for their review work. A peer reviewer on this manuscript has declared serving as a consultant for Janssen, Novartis, and Abbvie, as well as an investigator for Amgen, Abbvie, Eli Lilly, Pfizer, Celgene, Valeant, Janssen, and Novartis. The remaining peer reviewers have no relevant financial relationships to disclose.