Cost-Utility Analysis of Biological Therapies In Psoriasis Using Real World Evidence

Abstract

To assess the cost-utility of biological therapies in the treatment of adults with moderate-to-severe psoriasis, using evidence from real-world data. A Markov model was developed to compare different sequences of biological therapies and apremilast for the management of adult psoriasis patients with inadequate response to conventional disease-modifying anti-rheumatic drugs (cDMARD-IR). Efficacy and safety data were derived from published network meta-analyses. The drug survival data in the model was derived from the DERMBIO registry. Benefits were measured in quality adjusted life years (QALYs) and were derived from published EQ-5D data from the BADBIR registry (Iskandar et al, 2017). Dermatology Quality of Life Index (DLQI) data were also reported, and we estimated alternative utility values by mapping DLQI to EQ-5D using several published mapping algorithms. Health care resource use and costs were calculated based on data from published literature and public UK sources. The base case analysis included treatments for which survival data was available (adalimumab, etanercept, infliximab, ustekinumab), with the remaining therapies tested in scenario analyses using different survival and quality of life assumptions. Parameters related to efficacy, cost and utility were tested in sensitivity analysis. Base case results estimated that sequences with ustekinumab as first-line therapy had significantly better overall drug survival than all other biologics as first-line treatment for psoriasis, and were therefore more cost-effective. Scenario analysis with newer therapies suggested that apremilast, secukinumab and ixekizumab would require significantly better first-line drug survival, quality of life improvements and/or reduced pricing to achieve similar cost-effectiveness. The model was sensitive to the assumptions of drug survival as well as the different utility mapping algorisms. The results of this analysis with real-world drug survival data suggest that ustekinumab represents a more cost-effective treatment than other biologics as a first-line treatment for cDMARD-IR patients with psoriasis.