OBJECTIVES: Psoriasis is a chronic inflammatory disease that affects mainly the skin and joints leading to social difficulties. The Brazilian Clinical Protocol of Psoriasis recommends biological agents in case of contraindication, intolerance or failure to non-biological systemic treatment. This study aimed to analyze the efficiency of nationally licensed biological agents for the treatment of moderate to severe plaque psoriasis, from the Brazilian Public Health System perspective.

METHODS: We developed a decision tree model attached to a Markov model to estimate costs per Quality Adjusted Life Years (QALY) of six biological treatment strategies (ixequizumab; secuquinumab; ustequinumab; risanquizumab; adalimumab and infliximab) for plaque psoriasis moderate to severe in adults. For each treatment strategy, we conducted deterministic and probabilistic sensitivity analysis and a cost-effectiveness threshold analysis using the efficiency frontier approach.

RESULTS: Analyzing the efficiency frontier, we detected the dominance of infliximab and secuquinumab by adalimumab, ustequinumab and ixequizumab. Adalimumab is the most cost-effective strategy up to a willingness-to-pay of approximately $37.424/QALY followed by ustequinumab up to a willingness-to-pay of $65.492/QALY.

CONCLUSIONS: The treatment effectiveness, expressed in QALY, is similar between the biological agents assessed, but we observed expressive differences in incremental costs. Adalimumab, followed by ustequinumab and, finally, ixequizumab are more likely to be cost-effective per willingness-to-pay. Following the efficiency profile of available treatments at Brazilian Public Health System, it would be necessary a price reduction of risanquizumab, secuquinumab and ixequizumab in 55.1%, 10.74% and 9.1%, respectively.