Health Canada approved apremilast in 2014 as an oral therapy for the treatment of moderate-to-severe plaque psoriasis. We compare the cost-effectiveness of apremilast and available biologic therapies relative to standard of care (SoC) in adult psoriasis patients who have failed to respond, have a contraindication, or are intolerant to conventional systemic therapies from the perspective of the Canadian public health care system.

METHODS:

A 10-year Markov state transition cohort model was developed to compare biologics (adalimumab, etanercept, infliximab, biosimilar infliximab, ustekinumab, secukinumab) or apremilast to SoC alone (defined as non-systemic treatments and narrowband ultraviolet-B therapy). Response was assessed using the Psoriasis Area and Severity Index 75 (PASI-75) at the end of the trial period (12-16 weeks) for each therapy. Non-responders and dropouts were assumed to receive SoC. Response to SoC was assessed at 12 weeks based on the response rate observed in the placebo arm. Utility gains by PASI-75 were derived from the apremilast clinical trial program, and comparative efficacy data were obtained from a network meta-analysis. Drug costs were quoted from the Ontario Drug Benefit Formulary/Comparative Drug Index (2016), and costs associated with physician visits and treatment monitoring were sourced from the Ontario Health Insurance Plan (OHIP). A 5% annual discount rate was applied to costs and quality-adjusted life-years (QALYs). All-cause mortality was included for all health states.

RESULTS:

The cost per QALY gained for apremilast compared to SoC was lower (C$83,480/QALY) than for all other biologics (ranging from C$94,062/QALY for SEB biosimilar infliximab to C$179,676/QALY for infliximab). The cost-effectiveness frontier was defined by apremilast and SEB biosimilar infliximab. Conclusions from the base case analysis were robust in the deterministic and probabilistic sensitivity analyses. CONCLUSIONS:

In Canada, compared to biologics, orally administered apremilast is the most cost-effective option vs. SoC in this model for moderate-to-severe plaque psoriasis treatment.