Cost per responder for guselkumab versus secukinumab in the United States based on a head-to-head trial of moderate to severe plaque psoriasis

Figures & data

Table 1. Dosing and unit prices and 44-week and annual drug costs in the United States for guselkumab and secukinumab: induction and maintenance years.

Biologic	Dosing	Pricing	Trial treatment period (44 Weeks)		Induction year (52 Weeks)		Maintenance year (52 Weeks)
			Number of doses	44 week cost	Number of doses	Annual cost	Number of doses	Annual cost
Guselkumab	100 mg Administered by subcutaneous injection at week 0, week 4, and every 8 weeks thereafter^a	WAC^b^,^cper 100 mg: $10,859.46	7	$76,016.22	8	$86,875.68	6	$65,156.76
Secukinumab	300 mg dose (2 × 150 mg), at weeks 0, 1, 2, 3, 4 and then every 4 weeks thereafter^a	WAC^b^,^c per 300 mg: $5,178.91	15	$77,683.65	17	$88,041.47	12	62,146.92

WAC: wholesale acquisition cost.

^aUnited States Food and Drug Administration–labeled dose; trial efficacy outcomes were measured at 48 weeks, but biologic treatment was only given through 44 weeks.

^bThe WAC is a published list price. Wholesale acquisition cost does not account for any discounts, price concessions, or charge backs extended to wholesalers or other end users. It is not intended to represent an actual sales price to customers. Wholesalers and distributors determine the actual sales price to end-user customers.

^cWholesale acquisition cost as of August 14, 2019. Source: IBM Micromedex® RED BOOK® [14].

Figure 1. Percentage of patients achieving PASI 75, 90, and 100 response at 48 weeks in the ECLIPSE study^a. PASI: Psoriasis Area and Severity Index; PsO: psoriasis. ^aThe PASI was used to measure three levels of PsO improvement from baseline: PASI 75 (≥75% improvement), PASI 90 (≥90% improvement), and PASI 100 (100% improvement). Source: Reich et al [8]; Janssen data on file, 2019.

Figure 2. United States cost per responder for three PASI response levels: 48-week trial period^a. PASI: Psoriasis Area and Severity Index. ^aUsing Wholesale Acquisition Cost as of August 14, 2019. Source: IBM Micromedex® RED BOOK® [14].

Figure 3. United States cost per responder for three PASI response levels: induction year^a. PASI: Psoriasis Area and Severity Index.^a Using wholesale acquisition cost as of August 14, 2019. Source: IBM Micromedex® RED BOOK® [14].

Figure 4. Cost per responder for all three PASI response levels: first maintenance year^a. PASI: Psoriasis Area and Severity Index. ^aUsing wholesale acquisition cost as of August 14, 2019. Source: IBM Micromedex® RED BOOK® [14].

Table 2. Cost per responder^a in the United States and number needed to treat: all study patients.

	Guselkumab	Secukinumab
Cost per responder (CPR) 48-week trial period
PASI 75	$82,537	$93,034
PASI 90	$89,960	$110,977
PASI 100	$ $130,612	$160,503
Cost per responder (CPR) induction year
PASI 75	$94,328	$105,439
PASI 90	$102,811	$125,744
PASI 100	$149,271	$181,904
Cost per responder (CPR) first maintenance year
PASI 75	$70,746	$74,427
PASI 90	$77,109	$88,781
PASI 100	111,953	$128,403
Number needed to treat (NNT) 48-week trial efficacy endpoint and assumed value for induction or first maintenance year
PASI 75	1.09	1.20
PASI 90	1.18	1.43
PASI 100	1.72	2.07

CPR: cost per responder; NNT: number needed to treat; PASI: Psoriasis Area and Severity Index.

^aThe PASI was used to measure three levels of PsO improvement (response) from baseline: PASI 75 (≥75% improvement), PASI 90 (≥90% improvement), and PASI 100 (100% improvement).

Figure 5. Percentage of patient subgroups achieving a PASI 90 response at 48 weeks by prior treatment experience^a. PASI: Psoriasis Area and Severity Index; PsO: psoriasis. ^aThe PASI was used to measure the level of PsO improvement from baseline: PASI 90 (≥90% improvement). Source: Blauvelt et al. [15].

Table 3. NNT according to previous psoriasis treatment in PASI 90 responders at 48 weeks: scenario analyses.

Population	Guselkumab	Secukinumab
All study population	1.18	1.43
Previous nonbiologic systemic treatment	1.20	1.46
Previous biologic systemic treatment	1.23	1.55
Previous biologic or nonbiologic systemic drug treatment	1.20	1.46
Previous treatment with TNF inhibitors	1.30	1.70
Previous treatment with IL-12/IL-23 or IL-23 inhibitors	1.36	1.76
Previous treatment with IL-17 inhibitors	1.17	1.47

IL: interleukin; NNT: number needed to treat; PASI: Psoriasis Area and Severity Index; TNF: tumor necrosis factor.

^aPatient subgroups were not mutually exclusive; some patients had previously been treated with more than one systemic nonbiologic and/or biologic drug.

Table 4. Costs per responder according to previous psoriasis treatment among PASI 90 responders: scenario analyses.

Population^a	48-Week trial period CPR		Induction year CPR		First maintenance year CPR
	Guselkumab	Secukinumab	Guselkumab	Secukinumab	Guselkumab	Secukinumab
All patients	$89,960.02	$110,976.64	$102,811.46	$125,773.53	$77,108.59	$88,781.31
Previous nonbiologic systemic treatment	$91,585.81	$113,241.47	$104,669.49	$128,340.34	$78,502.12	$90,593.18
Previous biologic systemic treatment	$93,386.02	$120,626.79	$106,726.88	$136,710.36	$80,045.16	$96,501.43
Any previous systemic treatment	$91,365.65	$113,738.87	$104,417.88	$128,904.06	$78,313.41	$90,991.10
Previous treatment with TNF inhibitors	$98,979.45	$132,115.05	$113,119.38	$149,730.39	$84,839.53	$105,692.04
Previous treatment with IL-12/IL-23 or IL-23 inhibitors	$103,705.62	$136,766.99	$118,520.71	$155,002.59	$88,890.53	$109,413.59
Previous treatment with IL-17 inhibitors	$88,907.86	$114,072.91	$101,608.98	$129,282.63	$76,206.74	$91,258.33

CPR: cost per responder; IL: interleukin; PASI: Psoriasis Area and Severity Index; TNF: tumor necrosis factor.

^aPatient subgroups were not mutually exclusive; some patients had previously been treated with more than one systemic nonbiologic and/or biologic drug.

IBM Watson Health. IBM Micromedex® RED BOOK® [cited 2019 Aug 14]. Available from: http://www.micromedexsolutions.com.

 Google Scholar

Reich K, Armstrong AA, Langley RG, et al. Guselkumab versus secukinumab for the treatment of moderate-to-severe psoriasis (ECLIPSE): results from a phase 3, randomized controlled trial. Lancet. 2019;7394(10201):831–839.

 Web of Science ®Google Scholar

Blauvelt A, Vender R, Spelman L, et al. Efficacy of guselkumab versus secukinumab in patients with moderate to severe plaque psoriasis in subgroups defined by previous psoriasis medication history: results from the ECLIPSE study. 2019. Presented the 28th Congress of the European Academy of Dermatology and Venerology; 2019 Oct 9; Madrid, Spain.

 Google Scholar