Cost per response for guselkumab versus adalimumab in the United States using data from a head-to-head trial in moderate-to-severe plaque psoriasis

Figures & data

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

Biologic	Dosing	Pricing	Induction year (52 weeks)		Maintenance year (52 weeks)
			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^,^c per 100 mg: $10,859.46	8	$86,876	6	$65,157
Adalimumab	80 mg initial dose (2 x 40 mg), followed by 40 mg every other week starting 1 week after initial dose^a	WAC^b^,^c per 40 mg: $2,587.05	28	$72,437	26	$67,263

^a US FDA labeled dose.

^b The WAC is a published list price. Wholesale acquisition cost does not contain 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.

^c Wholesale acquisition cost as of March 19, 2019.

Source: Thompson’s Online Micromedex Red Book¹².

Abbreviation. WAC, wholesale acquisition cost.

Figure 1. Percentage of patients reaching PASI 75, 90, and 100 response at 48 weeks in the VOYAGE 1 study (The PASI was used to measure three levels of PsO symptom improvement from baseline: PASI 75 (≥75% improvement), PASI 90 (≥90% improvement), and PASI 100 (100% improvement)). Source: Blauvelt et al.⁵

Abbreviations. PASI, Psoriasis Area and Severity Index; PsO, psoriasis.

Figure 2. United States cost per responder for three PASI response levels induction year (Using wholesale acquisition cost as of March 19, 2019). Source: Thompson’s Online Micromedex Red Book¹². Abbreviation. PASI, Psoriasis Area and Severity Index.

Figure 3. Cost per responder for three PASI response levels: maintenance year (Using wholesale acquisition cost as of March 19, 2019). Source: Thompson’s Online Micromedex Red Book¹². Abbreviation. PASI, Psoriasis Area and Severity Index.

Table 2. Cost per responder in the US and number needed to treat base-case and scenario analyses.^a

Scenario analysis^b	Guselkumab		Adalimumab
	Base case	Placebo adjusted scenario analysis	Base case	Placebo adjusted scenario analysis
Cost per responder (CPR), Induction year
PASI 75	$98,947	$105,817	$115,714	$127,306
PASI 90	$113,861	$118,359	$151,226	$160,972
PASI 100	$183,282	$185,632	$309,561	$317,707
Cost per responder (CPR), Maintenance year
PASI 75	$74,210	$79,363	$107,449	$118,213
PASI 90	$85,395	$88,769	$140,424	$149,474
PASI 100	$137,462	$139,224	$287,449	$295,014
Number needed to treat (NNT), Induction or Maintenance year
PASI 75	1.1	1.2	1.6	1.8
PASI 90	1.3	1.4	2.1	2.2
PASI 100	2.1	2.1	4.3	4.4

^a Placebo-adjusted scenario analyses subtracted the placebo response rate at week 16 from the 48-week response rates for each drug; efficacy was assumed to be the same for both the induction and maintenance years for both guselkumab and adalimumab.

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

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

Truven Health Analytics. Red Book. 2019 [cited 2019 Mar 19]. Available from: http://www.micromedexsolutions.com.

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Blauvelt A, Papp KA, Griffiths CEM, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: results from the phase III, double-blinded, placebo- and active-comparator, controlled VOYAGE 1 trial. J Am Acad Dermatol. 2017;76:405–417.

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