Budget impact model in moderate-to-severe psoriasis vulgaris assessing effects of calcipotriene and betamethasone dipropionate foam on per-patient standard of care costs

Abstract

Aims: To develop a budget impact model (BIM) for estimating the financial impact of formulary adoption and uptake of calcipotriene and betamethasone dipropionate (C/BD) foam (0.005%/0.064%) on the costs of biologics for treating moderate-to-severe psoriasis vulgaris in a hypothetical US healthcare plan with 1 million members.

Methods: This BIM incorporated epidemiologic data, market uptake assumptions, and drug utilization costs, simulating the treatment mix for patients who are candidates for biologics before (Scenario #1) and after (Scenario #2) the introduction of C/BD foam. Predicted outcomes were expressed in terms of the annual cost of treatment (COT) and the COT per member per month (PMPM).

Results: At year 1, C/BD foam had the lowest per-patient cost ($9,913) necessary to achieve a Psoriasis Area and Severity Index (PASI)-75 response compared with etanercept ($73,773), adalimumab ($92,871), infliximab ($34,048), ustekinumab ($83,975), secukinumab ($113,858), apremilast ($47,960), and ixekizumab ($62,707). Following addition of C/BD foam to the formulary, the annual COT for moderate-to-severe psoriasis would decrease by $36,112,572 (17.91%, from $201,621,219 to $165,508,647). The COT PMPM is expected to decrease by $3.00 (17.86%, from $16.80 to $13.80).

Limitations: Drug costs were based on Medi-Span reference pricing (January 21, 2016); differences in treatment costs for drug administration, laboratory monitoring, or adverse events were not accounted for. Potentially confounding were the definition of “moderate-to-severe” and the heterogeneous efficacy data. The per-patient cost for PASI-75 response at year 1 was estimated from short-term efficacy data for C/BD foam and apremilast only.

Conclusions: The introduction of C/BD foam is expected to decrease the annual COT for moderate-to-severe psoriasis treatable with biologics by $36,112,572 for a hypothetical US healthcare plan with 1 million plan members, and to lower the COT PMPM by $3.00.

Keywords:

• Psoriasis
• cost
• enstilar foam
• budget impact model
• number-needed-to-treat
• patient
• PASI-75
• formulary
• sensitivity analysis

Transparency

Declaration of funding

This study was sponsored and funded by LEO Pharma, Inc.

Declaration of financial/other interests

CVA is an advisor for Novo Nordisk and Pacira, an investigator for Pacira, and a consultant for LEO Pharma and Takeda. MK has nothing to disclose. SRF is a consultant for Abbvie, Advance Medical, Caremark, Celgene, Galderma, Gerson Lehrman Group, Guidepoint Global, Janssen, Kikaku, LEO Pharma Inc., Lilly, Merck & Co. Inc., Mylan, Novartis Pharmaceuticals Corporation, Pfizer Inc., Qurient, Sanofi, Suncare Research, and Xenoport; a speaker for Abbvie, Celgene, Janssen, LEO Pharma Inc., Lilly, Novartis Pharmaceuticals Corporation, and Taro; a founder, stockholder, and chief technology officer for Causa Technologies; and a majority owner of stock in Medical Quality Enhancement Corporation. SRF also receives grant support from Abbvie, Celgene, Galderma, Janssen, Novartis Pharmaceuticals Corporation, Pfizer Inc., Qurient, Sanofi, and Taro and royalties from Informa, UpToDate, and Xlibris. PZ was an employee of LEO Pharma Inc. at the time of this study. ML is an employee of LEO Pharma Inc. Peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

Writing assistance was provided by p-value communications and funded by LEO Pharma Inc.

Previous presentations

Poster was presented at the Academy of Managed Care Pharmacy (AMCP) Nexus 2016; October 3–6, 2016; National Harbor, MD.