OBJECTIVES:

Conventional synthetic disease modifying antirheumatic drugs (csDMARDs) was recommended in 2019 as first line therapy from Italian Drug Agency (AIFA) for the treatment of moderate to severe psoriasis. Updated local guidelines recommended methotrexate (MTX) as the drug of first choice. Nevertheless, MTX is reported by AIFA to be underused. Since no study evaluated jointly the first-line efficacy and costs of the most widely used biologic/biosimilar drugs (adalimumab, etanercept, secukinumab and ustekinumab) and methotrexate in Italy, a cost per responder analysis was performed.

METHODS:

A cost per responder model was developed based on efficacy data from a published Cochrane network meta-analysis. Drug costs included in the model were estimated on the basis of average regional tender prices. The primary analysis assessed the cost per responder of both Psoriasis Area and Severity Index (PASI) 90 and 75 at week 12 for the induction phase only. An additional analysis was conducted at 52 weeks, for the induction and maintenance phases, assuming the same efficacy reported at 12 weeks, in accordance with literature. A univariate sensitivity analysis was performed at 95% LCI and UCI.

RESULTS:

At week 12, the costs per responder PASI 90 and 75 were lower for methotrexate compared to the most widely used biologics/biosimilars in Italy, € 566.71 and € 529.95 respectively. In addition, methotrexate had the lowest cost per responder at week 52, € 2,455.72 and € 2,296.47 respectively. Furthermore, up to 12 (PASI 90) and 8 (PASI 75) additional patients could be treated with methotrexate, using the additional cost per responder of the other treatments as compared to methotrexate.

CONCLUSIONS:

The analysis showed a lower cost per responder for methotrexate than for adalimumab, etanercept, secukinumab and ustekinumab. For healthcare budget holders, this means using the saved resources to treat more patients.