OBJECTIVES: To assess the cost-effectiveness of brodalumab versus available biologics and best supportive care (BSC) in adult patients with moderate-to-severe plaque psoriasis from a Canadian public payer perspective.

METHODS: A decision tree followed by a Markov model was developed to compare brodalumab with etanercept, adalimumab, infliximab, ustekinumab 45mg, ustekinumab 90mg, secukinumab, ixekizumab, infliximab subsequent entry biologic, and BSC. Psoriasis Area Severity Index (PASI) response was assessed at the end of the induction period (10-16 weeks) for each comparator. Responders (defined as at least 75% reduction in baseline PASI score) continued initial therapy and maintained their PASI response until treatment discontinuation or death. Non-responders switched to BSC.

Comparative efficacy data were informed by a network meta-analysis. EQ-5D utility values associated with each PASI health state were derived from the brodalumab AMAGINE-1 study. Drug costs were obtained from the Ontario Drug Benefit Formulary and unit costs from the Ontario Health Insurance Plan. A 10-year time horizon was employed with 1.5% annual discount rate for costs and outcomes. Probabilistic analyses were conducted for base case and all scenario analyses.

RESULTS: The base case analysis demonstrated that brodalumab had an ICER of $118,741 per quality-adjusted life year versus BSC. The ICER for ixekizumab versus BSC is $152,703. All other comparators were either dominated or subject to extended dominance. The results were robust across a range of scenario analyses.

CONCLUSIONS: The model concluded that brodalumab is the most cost-effective option compared with publicly funded biologics for the treatment of moderate-to-severe plaque psoriasis in Canada. As such, the reimbursement of brodalumab will benefit the Canadian public by introducing a highly effective and most likely costs-savings alternative to the public payer system.