Comparative cost-effectiveness of tildrakizumab and other commonly used treatments for moderate-to-severe psoriasis

Abstract

Objectives

To compare the cost-effectiveness of tildrakizumab with other commonly used biologics and apremilast as the first-line treatment for moderate-to-severe plaque psoriasis from a US health plan’s perspective.

Methods

A 10-year cost-effectiveness model was developed to compare the incremental cost per extra month with a Psoriasis Area and Severity Index (PASI) 75 response. Patients were assumed to receive one of the treatments evaluated as their first-line treatment at the outset of the analysis. Nonresponders (PASI <75) discontinued their current treatment; 25% went on to receive a mix of topical therapies, phototherapies, and other systemic therapies, while 75% received a second-line therapy before receiving a mix of topical therapies, phototherapies, and other systemic therapies. Direct medical costs were calculated based on drug acquisition, administration, and monitoring costs.

Results

The incremental cost per extra month a patient had a PASI 75 response was lowest for brodalumab ($3,685), infliximab ($4,102), apremilast ($4,770), and tildrakizumab ($5,150), followed by risankizumab ($5,319), secukinumab ($5,675), guselkumab ($5,784), ixekizumab ($5,900), adalimumab ($5,943), ustekinumab ($6,131), etanercept ($6,618), and certolizumab pegol ($13,476).

Conclusion

Tildrakizumab was among the most cost-effective first-line treatments for moderate-to-severe psoriasis and was more cost-effective than risankizumab, secukinumab, guselkumab, ixekizumab, adalimumab, ustekinumab, etanercept, and certolizumab pegol.

Keywords:

• Psoriasis
• cost effectiveness
• biologic therapy
• apremilast

Acknowledgements

The authors thank Clare Byrne, PhD, for writing assistance. Part of this work was presented in poster format at the 2018 Nexus Meeting of the Academy of Managed Care Pharmacy, October 22–25, Orlando, FL, the 2019 American Academy of Dermatology, March 1, Washington DC, and the 2019 International Society for Pharmacoeconomics and Outcomes Research, May 21, New Orleans, LA.

Author contributions

XJ, YZ, JC, and THB were responsible for conception and design of the research. Economic modeling was carried out by XJ, JC, and THB; acquisition of data was carried out by YZ, XJ, and JC; XJ, YZ, JC, and THB were responsible for development of the draft manuscript; all authors were responsible for critical revision of the manuscript for important intellectual content.

Disclosure statement

YZ, AM, and SL are employees of Sun Pharma Inc. XJ, JC, and THB are employees of RTI Health Solutions, all of whom were contracted by Sun Pharma Inc. to support the study. SF received research, speaking and/or consulting support from Galderma, GSK/Stiefel, Almirall, Alvotech, Leo Pharma, BMS, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Ortho Dermatology, Abbvie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate and National Psoriasis Foundation. He is founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. AWA has served as a research investigator or consultant to Leo, AbbVie, UCB, Janssen, Lilly, Novartis, Ortho Dermatologics, Sun, Dermavant, BMS, Sanofi, Regeneron, Dermira, and Modmed; non-promotional speaker for AbbVie.

Additional information

Funding

This study was funded by Sun Pharmaceutical Industries, Inc. (Princeton, NJ, USA).