PSS3 INDUCTION COST PER RESPONDER OF BRODALUMAB COMPARED WITH OTHER BIOLOGICS APPROVED FOR PATIENTS WITH MODERATE TO SEVERE PSORIASIS IN CANADA

Abstract

Brodalumab is an anti-interleukin-17R antibody recently funded across several provinces in Canada for moderate-to-severe plaque psoriasis. This study estimated the cost per responder (CPR) of brodalumab at the end of induction period of therapy for adult moderate-to-severe psoriasis patients compared to currently approved biologics: adalimumab, etanercept, guselkumab, infliximab [innovator and subsequent entry biologics (SEB)], ixekizumab, secukinumab and ustekinumab. Comparative efficacy was obtained from a random effects multinomial Bayesian network meta-analysis of 43 Phase II/III clinical trials reporting Psoriasis Area Severity Index [PASI] response for biologics of interest at the end of induction period. The primary outcome was a ≥ 90 reduction in PASI (i.e., PASI 90), with PASI 75 and PASI 100 as secondary outcomes. Drug acquisition costs were sourced from the Ontario Drug Benefit Formulary and the IQVIA database DeltaPA. The CPR was calculated as the drug acquisition costs divided by the proportion of patients with PASI 90, 75, or 100, each outcome separately during the induction period. Costs were presented in Canadian dollars. The PASI 90 response was 67.2% for brodalumab and ranged from 23.7% (etanercept) to 68.2% (ixekizumab). The drug acquisition costs ranged from $5,160 (brodalumab) to $14,813 (infliximab - innovator). For PASI 90, the CPR for brodalumab was $7,679 compared with $12,346 for the infliximab-SEB, $16,967 (guselkumab), $18,502 (ixekizumab), $19,545 (ustekinumab-90), $20,710 (secukinumab), $22,136 (ustekinumab-45), $24,213 (adalimumab), $24,730 (infliximab, innovator), $41,112 (etanercept). For PASI 75 and PASI 100, the CPR for brodalumab was $5,837 and $13,797 respectively. These were followed by the infliximab SEB at $8,783 and $24,406 for PASI 75 and PASI 100. The CPR of brodalumab at the end of induction period is the lowest across the comparators for all three PASI outcomes, hence providing the best value for money for patients, prescribers and the healthcare system as a whole.