VACTS-PSO: A PAYER-ORIENTED VALUE FRAMEWORK INTEGRATING CLINICAL OUTCOMES, QUALITY OF LIFE, AND REAL-WORLD INTENSIFICATION COSTS IN PSORIASIS
Author(s)
Rafael Gama, MD, MBA.
Researcher, Instituto Praxhis Saúde e Sociedade, Curitiba, Brazil.
Researcher, Instituto Praxhis Saúde e Sociedade, Curitiba, Brazil.
OBJECTIVES: Value assessment models in psoriasis frequently prioritize PASI over DLQI outcomes (Clinical-Reported Outcomes (CROs) vs Patient-Reported Outcomes (PROs), while underestimating the economic impact of dose intensification in real-world clinical practice. In the Brazilian private healthcare system, access criteria for biologic therapies include either (PASI) >10 OR (DLQI) >10. This study aimed to develop and apply the Value-Adjusted Cost per Therapeutic Success for Psoriasis (VACTS-Pso), a payer-oriented framework integrating: Clinical effectiveness, Patient quality of life, and Real-World treatment dose intensification.
METHODS: A comparative economic model was developed for Guselkumab, Risankizumab, Ixekizumab, Tildrakizumab, Secukinumab, and Ustekinumab in psoriasis. Weighted averages of PASI90, DLQI≤1 achievement, and dose intensification rates were derived from published real-world studies. Therapeutic success was defined as the Composite Therapeutic Success Index (CTSI), calculated as CTSI=(%PASI90 + %DLQI≤1) /2 (higher is better). Annual biologic treatment costs were adjusted according to dose intensification and administration frequency observed. VACTS-Pso was expressed as a dimensionless value-efficiency score (lower scores=greater value efficiency), calculated as VACTS-Pso=(Annual cost x Adjust Intensification)/(CTSI).
RESULTS: CTSI values: (%) 80.6 Risankizumab, 77.7 Tildrakizumab, 63.6 Guselkumab, 62.2 Secukinumab, 61.1 Ustekinumab, 54.6 Ixekizumab. Intensification-adjusted annual treatment costs ranged from BRL 73,173 Tildrakizumab to BRL 172,891 Ustekinumab. Dose intensification varied across therapies and substantially impacted observed treatment costs. VACTS-Pso value-efficiency scores were: Tildrakizumab 942, Risankizumab 1,567, Guselkumab 1,834, Ixekizumab 2,065, Ustekinumab 2,828, and Secukinumab 2,355. Although Risankizumab demonstrated the highest composite therapeutic effectiveness according to CTSI, Tildrakizumab achieved the lowest value-adjusted cost per therapeutic success (Exchange rate: 1.0 USD=5.0 BRL; June 2026).
CONCLUSIONS: VACTS-Pso integrates clinical response, patient-reported QoL, and real-world dose intensification into a single value metric. In this exploratory application, Risankizumab demonstrated the highest therapeutic effectiveness, whereas Tildrakizumab achieved superior balanced clinical-economic efficiency. These findings suggest that multidimensional value-based frameworks may support healthcare decision-making in real-world settings.
METHODS: A comparative economic model was developed for Guselkumab, Risankizumab, Ixekizumab, Tildrakizumab, Secukinumab, and Ustekinumab in psoriasis. Weighted averages of PASI90, DLQI≤1 achievement, and dose intensification rates were derived from published real-world studies. Therapeutic success was defined as the Composite Therapeutic Success Index (CTSI), calculated as CTSI=(%PASI90 + %DLQI≤1) /2 (higher is better). Annual biologic treatment costs were adjusted according to dose intensification and administration frequency observed. VACTS-Pso was expressed as a dimensionless value-efficiency score (lower scores=greater value efficiency), calculated as VACTS-Pso=(Annual cost x Adjust Intensification)/(CTSI).
RESULTS: CTSI values: (%) 80.6 Risankizumab, 77.7 Tildrakizumab, 63.6 Guselkumab, 62.2 Secukinumab, 61.1 Ustekinumab, 54.6 Ixekizumab. Intensification-adjusted annual treatment costs ranged from BRL 73,173 Tildrakizumab to BRL 172,891 Ustekinumab. Dose intensification varied across therapies and substantially impacted observed treatment costs. VACTS-Pso value-efficiency scores were: Tildrakizumab 942, Risankizumab 1,567, Guselkumab 1,834, Ixekizumab 2,065, Ustekinumab 2,828, and Secukinumab 2,355. Although Risankizumab demonstrated the highest composite therapeutic effectiveness according to CTSI, Tildrakizumab achieved the lowest value-adjusted cost per therapeutic success (Exchange rate: 1.0 USD=5.0 BRL; June 2026).
CONCLUSIONS: VACTS-Pso integrates clinical response, patient-reported QoL, and real-world dose intensification into a single value metric. In this exploratory application, Risankizumab demonstrated the highest therapeutic effectiveness, whereas Tildrakizumab achieved superior balanced clinical-economic efficiency. These findings suggest that multidimensional value-based frameworks may support healthcare decision-making in real-world settings.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PT19
Topic
Economic Evaluation, Health Technology Assessment, Patient-Centered Research
Topic Subcategory
Value Frameworks & Dossier Format
Disease
Biologics & Biosimilars, Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), No Additional Disease & Conditions/Specialized Treatment Areas, Sensory System Disorders (Ear, Eye, Dental, Skin), Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)