Cost Effectiveness of Moderate to Severe Psoriasis Therapy with Etanercept and Ustekinumab in the United States

Abstract

Limited information is available on the cost effectiveness of ustekinumab and alternative biologic treatments in a United States (US) setting. Given the recent head-to-head clinical trial study of ustekinumab and etanercept, an economic model comparing the two treatments can be constructed. Etanercept and ustekinumab are indicated for the treatment of chronic moderate to severe plaque psoriasis in adult patients who are candidates for phototherapy or systemic therapy. Clinical trials have evaluated the efficacy of ustekinumab, an anti-cytokine biologic, for the treatment of moderate to severe psoriasis. This study evaluated the cost effectiveness of ustekinumab compared with etanercept from a US societal perspective. A Markov model was constructed to simulate the incremental cost per quality-adjusted life-year (QALY) gained every 12weeks over a base-case 3-year time horizon. A hypothetical patient cohort was based on the characteristics of the phase III Active Comparator Psoriasis Trial (ACCEPT). The main outcome measures were costs and QALYs, which were estimated from the US societal perspective. Costs, utilities, treatment strategy, and resource use estimates were obtained from relevant literature. All costs were adjusted to 2011 US dollars. A 3% annual discount rate was applied to costs and QALYs. Incremental cost-effectiveness ratios were in US dollars per QALY gained. For the base-case 3-year time horizon, the incremental cost-effectiveness ratio comparing ustekinumab 90mg with etanercept 50mg was US$384,401 per QALY gained. Ustekinumab 45mg dominates etanercept 50mg for the same time horizon. These results were robust to sensitivity analyses involving treatment strategy, transition probabilities, valuing outcomes, and resource use and costs. The probabilistic sensitivity analysis suggests ustekinumab 90mg has a minimal (4%) chance of being cost effective compared with etanercept 50mg at a willingness-to-pay threshold of US$150,000 per QALY improvement. For the same threshold, ustekinumab 45mg has a high (88%) chance of being cost effective compared with etanercept 50mg. Under typical US willingness-to-pay cutoffs, ustekinumab 90mg is not cost effective compared with etanercept 50mg therapy in moderate to severe psoriasis patients for the base-case 3-year time horizon. Ustekinumab 45mg dominates etanercept 50mg therapy for an equivalent patient psoriasis severity and time horizon.