Cost per additional responder for ixekizumab and other FDA-approved biologics in moderate-to-severe plaque psoriasis

Abstract

Background: Evidence of the cost-efficacy of ixekizumab for the treatment of moderate-to-severe plaque psoriasis (PsO) in the US is limited.

Objective: To estimate the number needed to treat (NNT) and monthly cost of achieving one additional Psoriasis Area and Severity Index (PASI) 75, 90, and 100 responder for ixekizumab and other Food and Drug Administration (FDA)-approved biologics in PsO.

Methods: A network meta-analysis estimated the probability of achieving PASI 75, 90, or 100 response during induction for each biologic. NNTs were calculated using response difference of each respective biologic vs placebo at the end of induction. Monthly costs per additional PASI responder were based on FDA-approved doses, wholesale acquisition costs, and induction NNTs.

Results: Induction NNTs for ixekizumab 80 mg once every 2 weeks (Q2W) relative to placebo were consistently lower across all levels of clearance compared with the other biologics. Monthly cost per additional responder was lowest for ustekinumab 45 mg at PASI 75 and for secukinumab 300 mg and ixekizumab 80 mg Q2W at PASI 90. Ixekizumab 80 mg Q2W had the lowest cost for PASI 100.

Conclusion: In this analysis, ixekizumab is the most cost-efficient biologic in the US when targeting complete resolution, as measured by PASI 100 in PsO.

Keywords:

• Moderate-to-severe plaque psoriasis
• ixekizumab
• FDA-approved biologics
• network meta-analysis
• number needed to treat
• cost per additional responder
• Psoriasis Area Severity Index (PASI)

Transparency

Declaration of funding

The study was funded by Eli Lilly and Company.

Declaration of financial/other interests

SAS, SAF, RB, DA, AS, BZ, and SH are all full-time employees and stock holders of Eli Lilly and Company. CL has consulted for and/or been an Advisory Board Member for Abbvie, Amgen, Boehringer-Ingelheim, Dermira, Eli Lilly and Company, Janssen, Leo, Pfizer, Sandoz, and UCB and Vitae; has been an Investigator for Actavis, Abbvie, Amgen, Boehringer-Ingelheim, Celgene, Coherus, Cellceutix, Corrona, Dermira, Eli Lilly and Company, Galderma, Glenmark, Janssen, Leo Pharma, Merck, Novartis, Novella, Pfizer, Sandoz, Stiefel, Wyeth; and attended a Speaker’s bureau for Abbvie, Celgene, Novartis and Eli Lilly and Company.

Acknowledgments

The authors thank Sue Williamson and Caroline Spencer (Rx Communications, Mold, UK) for medical writing assistance during the preparation of this manuscript, which was funded by Eli Lilly and Company.