Health Economic Assessment of Optimal Biological Treatment for Moderate-to-Severe Psoriasis

Background There is limited guidance on which biologic therapies should be prioritised for the treatment of moderate-to-severe psoriasis, amongst the many available options. New mode-of-action biologics, as well as recently available biosimilars for existing biologics, continue to be developed making the choice of treatment sequence increasingly complex. Objectives The aim of this analysis was to develop a cost-effectiveness model to determine the optimal placement of biologic therapies on the treatment pathway for psoriasis in the UK. Methods A cohort-based Markov model was developed in Microsoft Excel, from the perspective of the National Health Service and Personal and Social Services in the UK. The model followed a hypothetical cohort of patients over a lifetime. The health states in the model were defined by Psoriasis Area and Severity Index response. In the model, patients could receive a total of four separate treatments, including three active interventions and best supportive care. Results A fully incremental analysis was undertaken on a subset of commonly used treatment sequences. The results of the list price analyses determined the most cost-effective sequence to be adalimumab biosimilar followed by ustekinumab, secukinumab, then best supportive care. This sequence is associated with total costs of 78,731 pound and total quality-adjusted life-years of 14.74 over a patient's lifetime. Conclusions This research suggests that the optimal first-line treatment in the UK is adalimumab biosimilar. The optimal second-line and third-line treatments depend on the magnitude of confidential discounts applied to the biologic treatments.