Real-World Costs per Treatment Sequence and per Responder for Biologic Therapies in Moderate-to-Severe Plaque Psoriasis: Evidence From Three Italian Centers
Author(s)
Sergio Di Matteo, Statistic, M. Chiara Valentino, Political Science, Giacomo M. Bruno, PharmD, PhD, Chiara Martinotti, pharmacy, Giorgio Lorenzo Colombo, MASc.
S.A.V.E. Srl, Milan, Italy.
S.A.V.E. Srl, Milan, Italy.
OBJECTIVES: Biologic therapies have significantly improved the management of moderate to severe plaque psoriasis, but their long term cost implications are a key concern for healthcare systems. This study evaluates the costs of alternative biologic treatment sequences using real-world data from three dermatology centers in Italy (Verona, Genova, Torino).
METHODS: A pharmacoeconomic model was developed in Microsoft Excel according to ISPOR best practices, adopting the perspective of the Italian National Health Service (SSN) over a 3 year horizon. Data were retrospectively collected from 1,662 adult patients treated with biologics. Three treatment sequences starting with adalimumab and differing in second-line therapies were evaluated. The primary outcome was cumulative cost per patient; the secondary was cost per PASI90 responder at 52 weeks. Input included real-world treatment costs, discontinuation rates, and response data. Sensitivity analyses varied the second-line agents in Sequences 1 and 2.
RESULTS: The base sequence (adalimumab, brodalumab, guselkumab, ixekizumab) resulted in the lowest cumulative cost per patient at the third year (€17,426), compared to €18,184 in sequence 1 (adalimumab, risankizumab, guselkumab, ixekizumab) and €19,087 in sequence 2 (adalimumab, secukinumab, guselkumab, ixekizumab). An analysis of the cost per responder at the third year (PASI 90 at 52 weeks) showed that the base sequence and Sequence 1 yielded comparable outcomes, whereas Sequence 2 was associated with higher costs. In the sensitivity analysis, the base sequence remained the most cost favorable compared to Sequence 1 (tildrakizumab) and Sequence 2 (ustekinumab) in second line.
CONCLUSIONS: The results indicate that sequencing strategies have a substantial impact on the cost effectiveness of biologic treatments for psoriasis. The primary objective confirmed brodalumab as the most economically sustainable strategy across the simulations conducted. These findings may support evidence based decisions on the optimal positioning of biologic therapies within treatment pathways.
METHODS: A pharmacoeconomic model was developed in Microsoft Excel according to ISPOR best practices, adopting the perspective of the Italian National Health Service (SSN) over a 3 year horizon. Data were retrospectively collected from 1,662 adult patients treated with biologics. Three treatment sequences starting with adalimumab and differing in second-line therapies were evaluated. The primary outcome was cumulative cost per patient; the secondary was cost per PASI90 responder at 52 weeks. Input included real-world treatment costs, discontinuation rates, and response data. Sensitivity analyses varied the second-line agents in Sequences 1 and 2.
RESULTS: The base sequence (adalimumab, brodalumab, guselkumab, ixekizumab) resulted in the lowest cumulative cost per patient at the third year (€17,426), compared to €18,184 in sequence 1 (adalimumab, risankizumab, guselkumab, ixekizumab) and €19,087 in sequence 2 (adalimumab, secukinumab, guselkumab, ixekizumab). An analysis of the cost per responder at the third year (PASI 90 at 52 weeks) showed that the base sequence and Sequence 1 yielded comparable outcomes, whereas Sequence 2 was associated with higher costs. In the sensitivity analysis, the base sequence remained the most cost favorable compared to Sequence 1 (tildrakizumab) and Sequence 2 (ustekinumab) in second line.
CONCLUSIONS: The results indicate that sequencing strategies have a substantial impact on the cost effectiveness of biologic treatments for psoriasis. The primary objective confirmed brodalumab as the most economically sustainable strategy across the simulations conducted. These findings may support evidence based decisions on the optimal positioning of biologic therapies within treatment pathways.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE634
Topic
Clinical Outcomes, Economic Evaluation, Real World Data & Information Systems
Disease
Biologics & Biosimilars, Sensory System Disorders (Ear, Eye, Dental, Skin)