OBJECTIVES: Psoriasis is a chronic, immune-mediated disease of the skin and joints, with a global prevalence of 2-3%. Treatment options include topical treatment, phototherapy, conventional systemic drugs, and biologics. Psoriasis Area and Severity Index (PASI) 75 is accepted as a reasonable response to therapy. However, with advent of PASI90 being potentially achievable, data demonstrating relevant value associated with achieving PASI90 compared to PASI75 are indispensable. Objective: to estimate the economic burden of managing moderate-to-severe psoriatic patients in the Kingdom of Saudi Arabia (KSA) who achieve a clinical outcome of PASI75 and assess the cost-utility of achieving PASI90 using Risankizumab.

METHODS: A Markov-model was developed with a 12-week cycle length and 40-year time horizon from a healthcare payer perspective. Costs considered were drug acquisition, drug administration, medical resources use, adverse events management, and travel costs. The model compared the current treatment sequence Anti-TNF-alpha (Adalimumab), IL12/23 inhibitors (Ustekinumab), and IL-17A inhibitor (Secukinumab), as 1^st, 2^nd, and 3^rd line, respectively; targeting PASI75 versus IL-23 inhibitor (Risankizumab) as 1^st line treatment option, targeting PASI90.

RESULTS: Using the current treatment sequence and targeting PASI75 as a clinical outcome, the overall estimated cost of moderate-to-severe psoriasis management in KSA was USD 8.9 billion yielding 0.92 million (quality-adjusted life year) QALYs. The use of Risankizumab as 1^st line option targeting PASI90 yielded an overall cost of USD 8.5 billion and 0.95 million QALYs. The cost-savings were attributed to the lower healthcare resource utilization while using Risankizumab. The increase in QALY gained was related to the increased probability of achieving PASI90 while using Risankizumab (72.2%).

CONCLUSIONS: Targeting PASI90 using Risankizumab as a 1^st line treatment option for moderate‑to‑severe psoriasis patients’ was not only found dominant versus the current treatment options, yielding higher QALYs eventually at lower costs; but may also improve quality of life without additional cost.