What is the Most Cost-Effective Plaque Psoriasis Treatment?

Tildrakizumab was recently found to be a more cost-effective option than most of its competitors in a comparative trial involving patients with moderate to severe plaque psoriasis.

In new data presented at the American Academy of Dermatology (AAD) 2019 Annual Meeting in Washington, DC, this week, a team of investigators from the US, UK, and Sweden reported that interleukin 23 (IL-23)-targeting therapy tildrakizumab was among the most cost-effective first-line therapy for plaque psoriasis care that includes fellow humanized monoclonal antibodies adalimumab, brodalumab, guselkumab, infliximab, ixekizumab, secukinumab, and ustenkinumab.

The trial, which also showed the recently-approved therapy’s cost-effectiveness compared to apremilast and etanercept, has implications to the approximate 1.7 million insured US patients burdened with the chronic condition.

Tildrakizumab (ILUMYA) was approved by the FDA for the treatment of adults with moderate to severe plaque psoriasis who are eligible for systemic therapy or phototherapy, in March 2018. The Sun Pharma therapy was approved on the basis of the phase 3 reSURFACE 1 and 2 clinical trial results, showing improved patient skin clearance via the Psoriasis Area Sensitivity Index (PASI).

The IL-23 inhibitor prevents the protein’s interaction with its receptor, therefore block pro-inflammatory cytokine and chemokine release.

Investigators adopted a Markov model consisting of 4 PASI response-based health states for their cost-effectiveness trial. Their 10-year analysis assessed incremental cost per quality-adjusted life-years (QALYs) gained for each first-line therapy compared with a mix of topical therapy, phototherapy, or other systemic therapy.

They also analyzed scenarios to understand the cost impact of adverse events, including hospitalizations due to severe infection and nonmelanoma skin cancer, among others. Indirect costs and different treatment pathways for first-line treatment non-responsiveness were also assessed.

Drug costs were calculated based on wholesale acquisition costs, and direct medical costs included drug and administration costs, laboratory costs, and clinic visits costs.

Though it was found to be among the costliest therapies in year 1 of patient use, tildrakizumab was the fourth-lowest costing drug in year 2 and beyond, investigators reported. Among monoclonal antibodies, it was the second-best therapy in costs. Infliximab, apremilast, and brodalumab were the lowest-cost therapies assessed, respectively.

Per incremental costs per QALY gained, tildrakizumab again fared better than secukinumab, guselkumab, ixekizumab, adalimumab, ustekinumab, and etanercept—but worse than brodalumab, infliximab, and apremilast, respectively. Across the multiple cost scenarios considered, the treatment costs were similar to the incremental costs.

Investigators concluded that tildrakizumab, as a first-line therapy for plaque psoriasis, is more cost-effective measure than guselkumab, secukinumab, izekizumab, ustekinumab, adalimumab, or etanercept.

The study, “Cost-effectiveness of Tildrakizumab in US Patients with Moderate-to-Severe Plaque Psoriasis,” was presented at AAD 2019.

This article was originally published by MD Magazine.