OBJECTIVES: To estimate the cost-effectiveness of secukinumab ( Cosentyx®) compared with ustekinumab (Stelara®) in patients with moderate to severe plaque psoriasis from a Swedish societal perspective. METHODS: A cost-minimization analysis was conducted to estimate the total treatment costs (including drug acquisition, monitoring and indirect costs) of secukinumab versus ustekinumab over periods up to ten years. Indirect costs were measured by estimated work productivity loss in three improvement categories incl. PASI <50, PASI 50-74, PASI>75. Data on PASI responses were based on head-to-head trial (CLEAR).  Primary outcomes were total treatment costs over a time horizon of 1-10 years, and total costs per patient achieving PASI75 and PASI90 (achieving clear or almost skin). Sensitivity analysis was performed to test the robustness of the model. RESULTS: Secukinumab had higher treatment initiation costs, but lower maintenance costs than ustekinumab. From year 2 onwards, secukinumab was cost-saving compared to ustekinumab. Total treatment costs after 2 years were 338’022SEK and 339’550SEK for secukinumab and ustekinumab respectively, resulting in savings of 1’529SEK. Extending the time period to 10 years resulted in savings of 50’460SEK. Based on the CLEAR study, a significantly higher proportion of patients reached PASI75 and PASI90 with secukinumab vs ustekinumab (93% and 83% PASI75; 79% v 58% PASI90). Considering a 2-year time horizon, the average total cost per patient reaching PASI75 was 363’020SEK for secukinumab compared to 410’647SEK for ustekinumab. Corresponding numbers for PASI90 were 427’648SEK and 589’375SEK. Univariate sensitivity analyses showed that base-case results were robust CONCLUSIONS: From a Swedish societal perspective, secukinumab was estimated to be cost-saving compared with ustekinumab. In addition to the lower total costs from year two onwards secukinumab has shown superior efficacy on PASI improvement and quality of life for patients, and can therefore be considered as the dominant treatment compared to ustekinumab.