PSY71 - Cost-Effectiveness of Apremilast In Moderate-To-Severe Psoriasis In Canada

Abstract

Health Canada approved apremilast in 2014 as an oral therapy for the treatment of moderate-to-severe plaque psoriasis. We compare the cost-effectiveness of apremilast and available biologic therapies relative to standard of care (SoC) in adult psoriasis patients who have failed to respond, have a contraindication, or are intolerant to conventional systemic therapies from the perspective of the Canadian public health care system. A 10-year Markov state transition cohort model was developed to compare biologics (adalimumab, etanercept, infliximab, biosimilar infliximab, ustekinumab, secukinumab) or apremilast to SoC alone (defined as non-systemic treatments and narrowband ultraviolet-B therapy). Response was assessed using the Psoriasis Area and Severity Index 75 (PASI-75) at the end of the trial period (12-16 weeks) for each therapy. Non-responders and dropouts were assumed to receive SoC. Response to SoC was assessed at 12 weeks based on the response rate observed in the placebo arm. Utility gains by PASI-75 were derived from the apremilast clinical trial program, and comparative efficacy data were obtained from a network meta-analysis. Drug costs were quoted from the Ontario Drug Benefit Formulary/Comparative Drug Index (2016), and costs associated with physician visits and treatment monitoring were sourced from the Ontario Health Insurance Plan (OHIP). A 5% annual discount rate was applied to costs and quality-adjusted life-years (QALYs). All-cause mortality was included for all health states. The cost per QALY gained for apremilast compared to SoC was lower (C$83,480/QALY) than for all other biologics (ranging from C$94,062/QALY for SEB biosimilar infliximab to C$179,676/QALY for infliximab). The cost-effectiveness frontier was defined by apremilast and SEB biosimilar infliximab. Conclusions from the base case analysis were robust in the deterministic and probabilistic sensitivity analyses. In Canada, compared to biologics, orally administered apremilast is the most cost-effective option vs. SoC in this model for moderate-to-severe plaque psoriasis treatment.