Study Examines Costs for Various Psoriasis Treatments

Boston—The economic burden of psoriasis in the United States is significant, as it is estimated to cost $11.25 billion annually in total direct and indirect healthcare costs, according to statistics from the National Psoriasis Foundation. Psoriasis is also becoming increasingly important for payers to investigate the value of new treatment options in the management of psoriasis, which was the focus of a recent study that was presented at the AMCP meeting during a poster session titled Cost per Responder of Apremilast versus Etanercept, Adalimumab, and Ustekinumab in Patients with Moderate to Severe Psoriasis.

The study’s aim was to estimate the cost per responder after 16 weeks of therapy for adult patients with psoriasis treated in the United States with oral apremilast 30 mg and the biologics etanercept 50 mg, adalimumab 40 mg, and ustekinumab 45 mg and 90 mg. Comparative efficacy data were obtained from a Bayesian network meta-analysis of biologic and oral systematic drugs as of October 2013. Therapy response was assessed using the 75% improvement in the Psoriasis Area and

Severity Index (PASI) score at the end of 12 or 16 weeks, depending on the clinical trial period for each drug.
The primary end point was a ≥75% reduction in PASI score at the end of the study period. Cost and efficacy comparisons were made at week 16, and the efficacy for drugs with a 12-week trial period were assumed to be maintained through 16 weeks. To derive drug treatment costs, the researchers used US wholesale acquisition cost (WAC) as of July and FDA-approved labeled dosing for induction of psoriasis treatment.

At week 16, the adjusted PASI-75 response rate was 31.9% for apremilast, 52.6% for etanercept, 65.9% for adalimumab, 68.6% for ustekinumab 45 mg, and 74% for ustekinumab 90 mg. The findings showed that apremilast had the lowest WAC per PASI-75 responder at both week 16 and 1 year in psoriasis patients ($18,938 and $34,472, respectively) compared with the 3 biologic therapies. The cost per PASI-75 at week 16 for biologic therapies was lowest for adalimumab ($20,294), followed by ustekinumab 45 mg ($21,479), etanercept ($33,508), and ustekinumab 90 mg ($39,857). At 1 year, ustekinumab 45 mg had the lowest cost per PASI-75 ($43,618) compared with adalimumab ($44,367), etanercept ($57,816), and ustekinumab 90 mg ($84,099).

In a scenario in which the payer has an annual budget of $1 million, the model calculated the number of treatable patients at 1 year by dividing the annual budget by the annual cost of treatment and the number of responders out of the treatable patients at 1 year. The model determined that apremilast had the most treatable patients (n=91) and responders at 1 year (n=29).

The researchers acknowledged study limitations. Because there is a lack of evidence from long-term, randomized, controlled trials versus placebo, the 1-year cost per responder assumed that short-term response rates were maintained for a full year. Efficacy results used in the model were indirectly derived from a network meta-analysis; therefore, unknown differences and cross-trial heterogeneity may confound these results.—Eileen Koutnik-Fotopoulos

This study was supported by Celgene Corporation.