Analysis: Is Initial Treatment with IL-17 Inhibitors Cost-Effective for Plaque Psoriasis?
For patients with moderate to severe plaque psoriasis with an inadequate response to methotrexate and phototherapy, initial targeted treatment with IL-17 inhibitors is the most effective treatment strategy, according to a cost-effectiveness analysis published in the Journal of Managed Care & Specialty Pharmacy.
While newer classes of targeted medications for moderate to severe plaque psoriasis are more effective than older drugs, they are also more expensive, researchers pointed out. They conducted their study to get a better picture of the clinical and economic outcomes likely with initial targeted treatment. The analysis spanned four drug classes: TNFα inhibitors (adalimumab, etanercept, and infliximab); PDE4 inhibitors (apremilast); IL-12/23 inhibitors (ustekinumab); and IL-17 inhibitors (ixekizumab, secukinumab, and brodalumab).
Over a 10-year period and compared with no treatment, IL-17 inhibitors showed the best incremental clinical benefit: ixekizumab demonstrated an estimated gain of 1.68 quality-adjusted life-years (QALYs); brodalumab, 1.64 QALYs; and secukinumab, 1.51 QALYs. The IL-12/23 inhibitor ustekinumab followed, showing a gain of 1.43 QALYs. Next were the TNFα inhibitors infliximab (1.27 QALYs), adalimumab (1.15 QALYs), and etanercept (0.97 QALYs). The PDE4 inhibitor apremilast demonstrated a gain of 0.87 QALYs.
Compared with 10-year costs of no targeted treatment ($66,451), costs of targeted treatment ranged from $137,080 with apremilast to $255,422 with ustekinumab.
At willingness-to-pay thresholds around $150,000 per QALY, the IL-17 inhibitors ixekizumab, secukinumab, and brodaluma are cost-effective initial treatments, researchers reported. At willingness-to-pay thresholds of $100,000 per QALY, infliximab and apremilast are the most cost-effective.
“Additional research is needed on whether the effectiveness of targeted agents changes when used after previously targeted agents,” researchers wrote.
—Jolynn Tumolo
Reference
Hendrix N, Ollendorf DA, Chapman RH, et al. Cost-effectiveness of targeted pharmacotherapy for moderate to severe plaque psoriasis. Journal of Managed Care & Specialty Pharmacy. 2018;24(12):1210-1217.
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