Evaluating the cost-effectiveness of secukinumab in moderate-to-severe psoriasis: a Japanese perspective

Figures & data

Table 1. Efficacy inputs for the model.

PASI response rate	Secukinumab 300 mg	Adalimumab	Infliximab	Ustekinumab 45 mg
4-week response
PASI <50	25.7%	51.3%	36.8%	49.5%
PASI 50–74	35.2%	31.9%	35.5%	32.5%
PASI 75–89	26.1%	13.3%	20.2%	14.1%
PASI 90–100	12.9%	3.5%	7.4%	3.8%
8-week response
PASI <50	7.6%	24.9%	7.6%	17.1%
PASI 50–74	18.0%	28.9%	18.0%	25.9%
PASI 75–89	35.2%	30.9%	35.2%	34.4%
PASI 90–100	39.2%	15.3%	39.2%	22.6%
12-week response
PASI <50	7.3%	20.4%	5.9%	11.7%
PASI 50–74	13.8%	22.6%	12.2%	17.8%
PASI 75–89	31.7%	32.7%	30.4%	33.6%
PASI 90–100	47.3%	24.3%	51.4%	37.0%
16-week response
PASI <50	4.5%	17.8%	7.4%	8.2%
PASI 50–74	9.2%	19.6%	12.5%	13.2%
PASI 75–89	19.4%	25.8%	22.7%	23.3%
PASI 90–100	66.9%	36.8%	57.5%	55.3%
Efficacy from extended treatment in partial responders
PASI ≥75	77.0%	17.0%	77.0%	84.0%^a

PASI response rate at a particular level (PASI <50, PASI =50–74, etc.) represents the percentage of patients achieving a corresponding reduction in their PASI score from the baseline. For example, PASI <50 indicates the percentage (or number) of patients who have achieved less than 50% reduction in their PASI score from baseline given a particular therapy.

Efficacy data obtained from the mixed-treatment comparison (fixed-effects ordinal analysis)⁵¹. Extended treatment data for secukinumab 300 mg obtained from Langley et al.⁹; adalimumab data from Gordon et al.⁵²; infliximab was assumed similar to secukinumab 300 mg; ustekinumab data from Papp et al.⁵³.

^aEfficacy data for ustekinumab 90 mg as partial responders were up-titrated to ustekinumab 90 mg from ustekinumab 45 mg. The efficacy data for the up-titrated ustekinumab 90 mg for extended treatment was assumed equivalent to efficacy data for ustekinumab 90 mg at week 16 in the mixed-treatment comparison.

Table 2. Cost inputs.

Treatment	Costs
Cost for biologic systemic treatments
Secukinumab 300 mg	¥146,264 per dose
Adalimumab 40 mg: pre-filled syringe	¥65,144 per dose
Infliximab (per average weight person)	¥332,972 per dose
Ustekinumab 45 mg: pre-filled syringe	¥438,739 per dose
Cost per visit or assessment
Pre-treatment assessment	¥34,320
Monitoring	¥8,110
Regular physician visit	¥730
Instruction for self-injection^b	¥6,500
Specialist care	¥2,500
Physician visit for IV^a	¥4,500
Cost per inpatient episode
Psoriasis	¥382,560
Sepsis	¥438,350
Lymphoma	¥248,190
Melanoma	¥264,820
NMSC	¥183,200
Tuberculosis^c	¥1,100,000
Pneumonia	¥239,260
Skin and soft tissue infection	¥250,960
Bone and joint infection	¥457,500
Urinary tract infection	¥264,960
Standard of care unit cost
Physician visits	¥730
Monitoring lab work: methotrexate	¥1,600
Monitoring lab work: cyclosporin treatment	¥1,600
UVB phototherapy	¥3,400

Co-payments for biologic systemic treatments can be calculated based on the details given under the subsection “Patient co-payment”. For costs regarding assessment or visit, inpatient episode, and standard of care, co-payment by patients can be calculated as 30% of total costs.

^aApplicable for infliximab only.

^bApplicable for secukinumab and adalimumab.

^cPaid completely by publicly funded healthcare, hence no patient co-pay cost applicable.

Cost inputs data were obtained from the Ministry of Health, Labour and Welfare⁵⁴.

Table 3. Probability of serious adverse events.

Adverse event	Secukinumab 300 mg	Adalimumab	Infliximab	Ustekinumab^a
Malignancies other than NMSC	0.004	0.006	0.077	0.006
NMSC	0.004	0.007	0.004	0.006
Severe infections	0.011	0.052	0.055	0.010

NMSC, non-melanoma skin cancer.

^aRepresents pooled ustekinumab 45 mg and 90 mg data.

Secukinumab data obtained from analysis of pooled data from clinical trials⁹; adalimumab, infliximab, and etanercept data obtained from product information and Dixon et al.⁵⁵; ustekinumab data obtained from product information.

Table 4. Costs, QALYs, and ICER values from the healthcare system perspective (considering total costs).

Treatment	Total costs	QALYs	ICER (secukinumab 300 mg vs comparator)
Secukinumab 300 mg	¥7,951,434	4.07
Adalimumab	¥6,289,767	3.87	¥8,418,222/QALY
Infliximab	¥8,961,400	4.04	Secukinumab dominates Infliximab
Ustekinumab 45 mg^a	¥8,466,420	4.03	Secukinumab dominates Ustekinumab

^aPartial responders at week 16 were up-titrated to ustekinumab 90 mg.

Table 5. Costs from the perspective of patient co-payment

Treatment	Co-payment costs
Monthly drug purchase
Secukinumab 300 mg	¥2,266,541
Adalimumab	¥1,881,873
Infliximab	¥1,498,207
Ustekinumab 45 mg^a	¥1,135,257
3-month drug purchase
Secukinumab 300 mg	¥1,158,705
Adalimumab	¥1,156,008
Infliximab	¥1,498,207
Ustekinumab 45 mg^a	¥1,135,257

^aPartial responders at week 16 were up-titrated to UST 90 (ustekinumab 90 mg).

Collins A, Hawe E, Vickers A, et al. Secukinumab 300 mg demonstrates highest probability of efficacy than other biologics in psoriasis: indirect comparison. Aust J Dermatol 2015;56:27-8

 Web of Science ®Google Scholar

Langley RG, Elewski BE, Lebwohl M, et al. Secukinumab in plaque psoriasis—results of two phase 3 trials. N Engl J Med 2014;371:326-38

 PubMed Web of Science ®Google Scholar

Gordon KB, Langley RG, Leonardi C, et al. Clinical response to adalimumab treatment in patients with moderate to severe psoriasis: double-blind, randomized controlled trial and open-label extension study. J Am Acad Dermatol 2006;55:598-606

 PubMed Web of Science ®Google Scholar

Papp KA, Langley RG, Lebwohl M, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). Lancet 2008;371:1675-84

 PubMed Web of Science ®Google Scholar

Various information of medical fee. Ministry of Health, Labour and Welfare; 2017. Available at: http://www.iryohoken.go.jp/shinryohoshu [Last accessed June 21, 2017]

 Google Scholar

Dixon WG, Watson K, Lunt M, et al. Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum 2006;54:2368-76

 PubMed Web of Science ®Google Scholar