OBJECTIVES

To assess the cost-effectiveness of certolizumab pegol (CZP) in adult patients with moderate to severe plaque psoriasis, who are eligible for systemic biologic therapy in Greece.

METHODS

A Markov model was developed and used over a patient’s lifetime, in which a treatment sequence starting with CZP 200mg every 2 weeks (following a 400mg loading dose at Weeks 0,2,4) was compared to one with adalimumab. Adalimumab was selected as the comparator because it was considered the most representative in Greek clinical practice, according to a local expert. Sequential biologics were ustekinumab, secukinumab and infliximab, for both treatment strategies. Patients failing infliximab received best supportive care as last line of treatment.

Treatment response was defined as 75% reduction in Psoriasis Area and Severity Index (PASI) score following the induction phase (10–16 weeks, depending on the treatment), obtained from a network meta-analysis. Non-responders moved to the next treatment line. Long-term treatment withdrawal and all-cause mortality rates were retrieved from official sources, and utility values from CZP trial data (PASI response). Following a public payer perspective, direct costs pertaining to drug acquisition, administration, and monitoring were considered. Results are presented as incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY) gained.

RESULTS

Replacing adalimumab with CZP in the treatment sequence was cost-effective, generating an ICER of €1,282 per QALY gained. Compared to the adalimumab sequence, the CZP sequence produced an estimated 0.07 additional QALYs (16.04 vs 15.98), at additional costs of €87 (€122,157 vs €122,071). One-way sensitivity and scenario analyses confirmed the cost-effectiveness of CZP. At the defined willingness-to-pay threshold of €34,000/QALY gained (twice the Greek per capita income), probabilistic sensitivity analysis showed that CZP had 100% probability of being cost-effective relative to the adalimumab sequence.

CONCLUSIONS

The CZP sequence was found to be cost-effective for moderate to severe plaque psoriasis in Greece.