Number needed to treat and costs per responder among biologic treatments for moderate-to-severe psoriasis: a network meta-analysis

Abstract

Background: The clinical benefits of biologic therapies for moderate-to-severe psoriasis are well established, but wide variations exist in patient response.

Objectives: To determine the number needed to treat (NNT) to achieve a 75% and 90% reduction in the Psoriasis Area and Severity Index (PASI-75/90) with FDA-approved agents and evaluate the incremental cost per PASI-75 or PASI-90 responder.

Methods: The relative probabilities of achieving PASI-75 and PASI-90, as well as NNTs, were estimated using a network meta-analysis. Costs (2017 USD) included drug acquisition and administration. The incremental cost per PASI-75 or PASI-90 responder for each treatment was estimated for the clinical trial period, and annually.

Results: Compared with supportive care, the NNT to achieve PASI-75 was 1.18 for ixekizumab, 1.29 for secukinumab 300 mg, 1.37 for infliximab, 1.48 for adalimumab, 1.53 for secukinumab 150 mg, 1.58 for ustekinumab, 2.25 for etanercept, and 3.71 for apremilast. The one-year incremental cost per PASI-75 responder relative to supportive care was $59,830 for infliximab, $88,775 for secukinumab 300 mg, $91,837 for adalimumab, $95,898 for ixekizumab, $97,363 for ustekinumab, $105,131 for secukinumab 150 mg, $129,665 for apremilast, and $159,328 for etanercept. Results were similar for PASI-90.

Conclusion: The NNT and incremental cost per responder are meaningful ways to assess comparative effectiveness and cost effectiveness among psoriasis treatments.

Keywords:

• Psoriasis
• network meta-analysis
• biologic therapy
• cost per responder
• number needed to treat

Transparency

Declaration of funding

This work was funded by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the publication.

Author contributions: Conceptualization and design: A.W.A., K.A.B., J.E.S., M.S., J.L., A.X.G., E.Q.W.; methodology: A.W.A., K.A.B., J.E.S., J.L., M.S., E.Q.W.; data curation, analysis and interpretation: K.A.B., J.E.S., J.L., M.S., E.Q.W.; supervision and validation: A.W.A., M.S., A.X.G., J.E.S., E.Q.W.; validation: A.W.A., K.A.B., J.E.S., M.S., A.X.G., E.Q.W.; writing – original draft: K.A.B., J.L., J.E.S., E.Q.W.; writing – review and editing: A.W.A., K.A.B., J.E.S., J.L., M.S., A.X.G., E.Q.W. All authors agreed to be accountable for all aspects of the work.

Declaration of financial/other relationships

A.W.A. has disclosed that she serves as investigator and/or consultant to AbbVie, Amgen, Janssen, Merck, Lilly, Celgene, Novartis, Pfizer, and Modernizing Medicine. K.A.B., J.E.S., J.L. and E.Q.W. have disclosed that they are employed by Analysis Group, Inc., which received consulting fees from AbbVie Inc. M.S. has disclosed that he was an employee of AbbVie at the time of the study’s conduct and may own AbbVie stock or stock options. A.X.G. has disclosed that he is an employee of AbbVie and may own AbbVie stock or stock options.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

Editorial assistance was provided by Shelley Batts, PhD, an employee of Analysis Group Inc., and was funded by AbbVie.