Apremilast is an orally administered, small-molecule phosphodiesterase-4 inhibitor. It has a novel mechanism of action, targeting multiple steps implicated in the pathogenesis of psoriasis. Apremilast was approved by the European Medicines Agency in 2015 for the treatment of moderate-to-severe chronic plaque psoriasis (PsO) in adult patients who failed to respond to or have a contraindication to, or are intolerant to other systemic therapies. We assessed the budget impact of introducing apremilast in the current treatment portfolio for psoriasis from the UK payer perspective. METHODS:

A 5-year budget impact model was developed using a prevalence-based approach. The target population was estimated based on the total UK population, annual population growth rate, prevalence of PsO, and proportion of patients with moderate-to-severe disease. The total psoriasis population was divided into 3 categories: untreated patients, patients receiving ≥1 conventional systemic non-biologic therapy (SNBT), and patients on biologics. Biologic treatments included adalimumab, etanercept, infliximab, secukinumab, and ustekinumab. Biosimilars for etanercept and infliximab were also considered. Drug costs were quoted from the British National Formulary (BNF) and the Monthly Index of Medical Specialties (MIMS). Administration costs were obtained from the National Clinical Guideline Centre (NCGC); physician visit and laboratory test costs were informed by National Health Service (NHS) reference costs, the NCGC, and literature values. RESULTS:

Over a 5-year period, the number of patients treated with apremilast was estimated to increase from 69 to 1,980. Inclusion of apremilast decreased the total budget by 2.19% (£735,221,377 vs. £751,645,055) relative to the world without. In the final year, drug acquisition costs decreased by 4.43% (£124,099,644 vs. £129,856,022), administration costs by 18.67% (£671,543 vs. £825,667), and monitoring costs by 2.81% (£21,291,886 vs. £21,907,514), yielding a net cost saving of 4.28%. CONCLUSIONS:  Inclusion of apremilast in the PsO treatment regimen in the UK was cost saving in all respects