Abstract
BackgroundBiologics are a good therapeutic option for severe, chronic plaque psoriasis; however, they come with significant cost to the health care system.ObjectiveTo conduct a cost-utility analysis of outpatient biologics (adalimumab, etanercept, guselkumab, ixekizumab, risankizumab, secukinumab, tildrakizumab, and ustekinumab) available to adults with severe, chronic plaque psoriasis from the perspective of the Australian health care system.MethodsA Markov cohort model was constructed to estimate the quality-adjusted life years (QALYs) and costs accrued for treatment pathways commencing with different first-line biologics, over a 96-week time horizon. The model adhered to the Australian Pharmaceutical Benefits Scheme eligibility criteria and guidelines.ResultsA biologic treatment pathway commencing on tildrakizumab was the most cost-effective first-line treatment (Australian dollar 39,930; total utility of 1.57 QALYs over 96 weeks). First-line secukinumab and risankizumab had incremental cost-utility ratios of Australian dollar 194,524/QALY and Australian dollar 479,834/QALY, respectively, when compared with first-line tildrakizumab.LimitationsThe efficacy and utility input parameters were derived from international randomized control trials and patients from the United Kingdom, respectively. Findings from this study cannot be generalized beyond Australia.ConclusionTildrakizumab may be considered as first-line treatment for adult patients with severe, chronic plaque psoriasis embarking on biologic therapy, from the economic perspective of the Australian health care system.
Highlights
In the last decade, the management of severe psoriasis has been revolutionized by the advent of biologics
A biologic treatment pathway commencing on tildrakizumab was the most cost-effective first-line treatment (Australian dollar 39,930; total utility of 1.57 quality-adjusted life years (QALYs) over 96 weeks)
Tildrakizumab may be considered as first-line treatment for adult patients with severe, chronic plaque psoriasis embarking on biologic therapy, from the economic perspective of the Australian health care system. ( JAAD Int 2021;5:1-8.)
Summary
The management of severe psoriasis has been revolutionized by the advent of biologics. Biologics generally have a more favorable side effect profile compared with those of conventional systemic therapies such as acitretin, methotrexate, or cyclosporine.[1] biologics are associated with significant acquisition costs. In Australia, the biologics available for psoriasis are the tumor necrosis factor-alpha (TNF-a) inhibitors: adalimumab, infliximab, and etanercept; the interleukin (IL)-12/23 inhibitor: ustekinumab; the IL-17. From the Faculty of Medicine and Healtha, Centre for Big Data Research in Healthc, and Faculty of Businessd, The University of New South Wales, Kensington; and Department of Dermatology, Liverpool Hospital, Liverpool.b. Supported by the University of New South Wales BSc(Med)Hons Program (to Miss Sun). Biologics are a good therapeutic option for severe, chronic plaque psoriasis; they come with significant cost to the health care system
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