OBJECTIVES

Risankizumab is a new IL-23 inhibitor approved by EMA (April 2019), currently reimbursed in Portugal to treat adult patients with moderate-to-severe psoriasis. Psoriasis is a chronic inflammatory, immune mediated disease characterized by erythematous plaques covered with silvery-white scales, with a 2% prevalence in Portugal. Managing psoriasis is still challenging due to its chronicity and ability to relapse, being needed to assess the most cost-effective treatment sequences. The aim of this study was to evaluate the cost-effectiveness of therapeutic sequences initiating with risankizumab against other biologic treatment sequences used in clinical practice (biosimilars included), among the approved population in Portugal.

METHODS

An excel-based Markov model was adapted to simulate a cohort of patients over a lifetime horizon. The Portuguese NHS perspective was adopted, with a 4% annual discount rate for costs and effects. All the mathematically possible therapeutic sequences were analysed, being clinically plausible sequences subsequently identified through an expert panel for risankizumab and comparators. The model considered three lines of treatment, each one with induction and maintenance phases. Within each treatment-related state, patients were distributed by level of PASI response. Patients with PASI90 at the induction phase went through to the maintenance phase and continued receiving the same treatment. Remaining patients switched to the next treatment line. Discontinuation and effectiveness rates were assumed to vary by treatment and therapeutic line.

RESULTS

Results suggest that risankizumab sequence is dominant versus all the sequences identified by the expert panel, allowing QALY gains between 0.01-0.45 and savings between 4,518€ and 21,965€ per patient. The probabilistic sensitivity analysis and the scenario analysis confirmed the dominance of risankizumab sequence across all the others.

CONCLUSIONS

Risankizumab is expected to provide clinically meaningful benefit and quality of life increase, while allowing for expressive economic savings in the treatment of adults with moderate-to-severe psoriasis.