OBJECTIVES: To evaluate the cost-effectiveness of ustekinumab in the treatment of psoriasis in the Finnish setting. METHODS: A sequential Markov cohort model was programmed in Excel using Visual Basic for Applications. First, the most frequently used treatment sequence (ustekinumab -> adalimumab -> etanercept -> infliximab -> maintenance, Finnish “current care”) was compared to the most used sequence prior to ustekinumab’s market authorization (adalimumab -> etenarcept -> infliximab -> maintenance, “past care” in Finland) in a confirmatory analysis setting. Then the incremental cost-effectiveness of all relevant treatment sequences was explored to find out the health economic relevance of current and past care sequences. The primary analysis outcomes were direct payer costs and quality-adjusted life years (QALY) gained. Secondary outcomes included Psoriasis Area and Severity Index (PASI) response years gained and Dermatology Quality of Life Index (DLQI) years avoided. Drugs, follow-up, drug administration, laboratory tests, adverse events and treatment failures as well as direct costs to patient were included as costs at 2014 price level. Initial treatment efficacy was based on a Bayesian network meta-analysis of randomized clinical trials, and treatment persistence was modeled based on recent real world registry studies. All results were discounted with 3% per annum during the 5-year modelling timeframe. RESULTS: The total discounted 5-year costs were €74,383 for the current care and €76,847 for the past care sequence. The respective QALYs were 3.895 and 3.825. Thus, the current care using ustekinumab dominated the past care without ustekinumab. PASI and DLQI results were in line with QALY results. Results were robust in the performed sensitivity analyses. Furthermore, in the explorative analysis of all relevant treatment sequences, ustekinumab was always part of the cheapest sequence. CONCLUSIONS: Ustekinumab is the most cost-effective treatment in the current Finnish psoriasis treatment practice, and its use is both clinically and health economically relevant.