OBJECTIVES: To determine the cost-effectiveness of secukinumab 300mg with and without uptitration versus risankizumab 150mg for the treatment of adults with moderate-to-severe plaque psoriasis (PsO), eligible for systemic biologic therapy in the UK, from a National Health Service (NHS) perspective.

METHODS: The model structure was a decision tree up to week 16, leading into a Markov model over a lifetime horizon. The model simulated patients’ transitions through one line of biologic therapy followed by non-biologic standard of care (SoC) and/or death. Transition probabilities were informed by a published network meta-analysis of Psoriasis Activity and Severity Index (PASI) responses and discontinuation rates due to loss of response (response defined as PASI≥75). Among patients with a body weight ≥90kg, non-responders (PASI<75) treated with secukinumab were uptitrated at week 16 by increasing the 300 mg dose from every four weeks to two weeks. All other Secukinumab non-responders and risankizumab non-responders discontinued treatment and move to SoC. Outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). In addition to the conventional model, a dynamic approach was considered by modelling incident cohorts.

RESULTS: Risankizumab resulted in a marginal incremental QALY gain versus secukinumab without the uptitration option. When secukinumab uptitration was considered, total QALYs were comparable between risankizumab and secukinumab, with incremental QALYs and costs approaching zero. Implementing the dynamic approach allowed to capture the lower long-term costs generated by secukinumab, making it a more cost-effective alternative compared to risankizumab. N.B. Numerical results to be reported in the conference presentation/poster.

CONCLUSIONS: The conventional cost-effectiveness approach demonstrates the similarity between risankizumab and secukinumab in terms of total costs and QALYs gained, particularly once uptitration is applied. The consideration of incident patients (under a dynamic approach) indicates that secukinumab generates lower long-term costs, representing a more cost-effective use of NHS resources for the treatment of PsO.