The cost-effectiveness of ustekinumab for moderate-to-severe psoriasis

Abstract

Given its chronicity and impact on quality of life, psoriasis is a costly disease. As new and better treatments are developed, the cost of treating psoriasis has risen. In this drug profile, the authors discuss ustekinumab, its pharmacokinetics, safety profile, and direct and indirect costs to determine its cost-efficacy. The authors searched PubMed with specific search phrases for clinical trials investigating this issue over 5 years. Eleven articles analyzed cost-effectiveness of ustekinumab, and the references of these articles were included. Studies limited to 12 weeks reported that ustekinumab may not be cost-effective as it has high cost per injection and is costly when loading doses are required. Studies that went beyond 12 weeks documented that, with ustekinumab’s infrequent dosing, it is cost-effective during the maintenance period.

Keywords:

• biologics
• direct
• expense
• indirect
• money
• Stelara
• therapeutics

Key issues

• Psoriasis is a costly disease to treat, but is also costly if it is not treated adequately.

• For patients under 100 kg, ustekinumab 45 mg is one of the most cost-effective biologic agents when considering its direct and indirect costs.

• Although ustekinumab is more expensive per dose, it is cost-effective over the long-term due to the sporadic dosing regimen.

• More convenient dosing not only leads to lower indirect costs, but also better adherence and disease control.

• Ustekinumab is associated with fewer side effects compared to other biologics.

• Treating patients over 100 kg generally requires a 90-mg dose and, therefore, it is not as cost-effective to treat patients over 100 kg with ustekinumab.

• Despite the discussion about cost-effectiveness, it may be difficult to determine what the patient will actually pay from their own pocket based on their insurance coverage.

Financial & competing interests disclosure

This study was not funded. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. SR Feldman is a speaker for Janssen and Novartis. He has also received grants from Galderma Laboratories, L.P., Janssen, Abbvie, Amgen, Stiefel/GlaxoSmithKline, Celgene and Anacor. He is a consultant for Amgen, Baxter, Caremark, Gerson Lehrman Group, Guidepoint Global, Hanall Pharmaceutical Co Ltd, Lilly, Merck, Mylan, Novartis, Pfizer, Qurient, Suncare Research and Xenoport. SR Feldman is also the founder and holds stock in Causa Research and holds stock and is majority owner in Medical Quality Enhancement Corporation. He receives Royalties from UpToDate and Xlibris. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.