OBJECTIVES: The objectives of this analysis were to determine annual costs of four commonly used biologic drugs to treat patients with moderate-to-severe psoriasis and compare their cost-effectiveness to that of the newly approved biologic drug, brodalumab.

METHODS: An Excel-based cost-effectiveness model from a U.S. perspective was developed to compare the average costs to health plans for treatment with adalimumab, brodalumab, ixekizumab, secukinumab, and ustekinumab for achieving Psoriasis Area and Severity Index (PASI) 75, 90, and 100 among moderate-to-severe psoriasis patients. Published drug efficacy and safety data, Wholesale Acquisition Costs (WAC 2017) for the biologics, drug dispensing fee, patient co-pay, drug contracting discount, and potential adverse event monitoring costs were incorporated into the model. Total annual costs to health plans associated with treatment with the 5 different biologics were estimated and cost-effectiveness compared using the estimated average cost per PASI 75, PASI 90, and PASI 100. Univariate and multivariate sensitivity analyses were also conducted.

RESULTS: Total annual costs to a health plan per patient with brodalumab, adalimumab, ixekizumab, secukinumab, and ustekinumab were estimated respectively at $38,538, $51,246, $65,484, $57,510, and $57,013. Mean annual treatment costs per PASI 75, 90, and 100 were the lowest for brodalumab, with the annual cost per PASI 75 for brodalumab, adalimumab, ixekizumab, secukinumab, and ustekinumab estimated at $48,782, $82,655, $77,957, $75,671, and $87,243; per PASI 90 at $51,383, $119,178, $94,904, $108,509, and $130,615; and per PASI 100 at $87,585, $284,702, $176,983, $205,393, and $366,645. Univariate and multivariable sensitivity analyses demonstrated consistent differences in annual health plan costs per patient associated with treatment with other biologics vs. brodalumab.

CONCLUSIONS: Among the biologic drugs commonly used for the treatment of moderate-to-severe psoriasis in the U.S., brodalumab was consistently the most cost-effective for cost per PASI 75, 90 and 100, which was largely driven by its lower WAC cost.