Presentation (CTI)

OBJECTIVES: Generalised pustular psoriasis (GPP) is a rare, chronic, neutrophilic, and severe, autoinflammatory disease. To date, there has been no established standard of care for GPP flares in the UK, with treatment relying on off-label systemic therapies and topical steroids originally developed for other conditions. These treatments are slow to elicit a response, and experts in England estimate that around 70% of moderate-to-severe flares require hospitalisation. This study estimated the cost-effectiveness of spesolimab (900 mg) intravenous infusion compared to best available care (BAC).
METHODS: The cost-effectiveness model comprised a three-state Markov model with health states designed to reflect GPP flares state, flare-resolved state, and death. The analysis covered 12 weeks from the perspective of the UK NHS and Personal Social Services. A daily cycle was used to reflect the transition of patients and to capture the healthcare resource and quality of life impact. Spesolimab was compared to BAC, which comprised systemic and biological treatments informed by UK clinical experts. Effisayil™ 1 trial data and a historical cohort from Effisayil 1 were used to model spesolimab and BAC outcomes, respectively. Data gaps were addressed through a structured expert elicitation exercise and analysis of Hospital Episode Statistics data.
RESULTS: In the base case analysis, as well as in the sensitivity analyses, spesolimab dominated BAC. The results of the one-way sensitivity analysis indicated that the primary drivers of the ICER were the percentage of patients treated as inpatient and the cost of spesolimab.
CONCLUSIONS: Spesolimab is estimated to be a cost-effective treatment compared to BAC at the WTP of £20,000. The introduction of spesolimab could potentially reduce hospitalisations by at least 50%, reduce the length of inpatient stay, and decrease the need for escalation to high dependency care compared with other treatments