OBJECTIVES: The 52-week treatment cost per patient achieving ≥75% reduction in Psoriasis Area Severity Index [PASI75 cost-per-responder (CPR)] and per patient attaining Dermatology Life Quality Index (DLQI) 0/1 (DLQI-0/1 CPR) was estimated in patients initiated and remaining on apremilast (APR) or switching to biologics, and patients hypothetically treated with biologics ab initio.

METHODS: APR-response data and proportion of patients switching from APR to biologics [2.4% (7/287)] were based on APRAISAL real-world 52-week prospective study conducted in Greece in bio-naïve adults with moderate plaque psoriasis. For biologic/biosimilar response rates, a stepwise search strategy was used based on published studies (≥52-week follow-up; real-world prospective/phase III; bio-naïve/low prior exposure to biologics; moderate/moderate-to-severe psoriasis). Biologics/biosimilars included: ustekinumab (UST), secukinumab (SEC), brodalumab (BROD), and adalimumab (ADA) originator; and ADA biosimilars 1-3 (ADAbs1-3). For patients switching from APR to biologics and those hypothetically treated with biologics ab initio, local public market share data were used.

RESULTS: For PASI75 CPR, prescription frequency of UST/SEC/BROD/ADA/ADAbs1/ADAbs2/ADAbs3 was assumed at 16.82/27.78/12.78/6.30/18.60/14.57/5.16% (scenario-1), while for DLQI-0/1 CPR, the relevant frequency of UST/SEC/ADA/ADAbs1/ADAbs2/ADAbs3 was assumed at 19.28/29.56/7.20/21.34/16.70/5.91% (scenario-2); for scenario-2, BROD was excluded due to lack of relevant published DLQI-0/1 response data. The 52-week treatment costs (based on drugs’ suggested dosing regimen per the local label and wholesale purchase prices) for APR/UST/SEC/BROD/ADA/ADAbs1/ADAbs2/ADAbs3 were €6,642.12/10,710.65/14,827.84/13,927.03/8,959.72/7,146.44/6,413.12/6,591.62. The 52-week PASI75 response rates considered for APR/UST/SEC/BROD/ADA were 72.6/78.2/91.6/87.0/56.0%; DLQI-0/1 response rates for APR/UST/SEC/ADA were 40.0/59.2/71.6/37.9%. The median annual cost/patient was €6,642.12 versus €10,710.65 (difference: €4,068.53) in scenario-1, and €6,642.12 versus €10,079.84 (difference: €2,317.60) in scenario-2 for ‘apremilast-initiated’ and ‘ab initio biologics’ group, respectively. The PASI75 CPR was €9,240.01 versus €14,507.76 (difference: €5,267.75 favoring APR), while the DLQI-0/1 CPR was €16,744.66 versus €19,408.21 (difference: €2,663.55 favoring APR).

CONCLUSIONS: These results suggest that apremilast may be a cost-effective option preceding biologics for patients with moderate plaque psoriasis.