OBJECTIVES: To estimate the cost per Psoriasis Area and Severity Index (PASI) ≥90 responder of secukinumab as first biologic treatment compared with adalimumab, etanercept, infliximab and ustekinumab over 16 and 52 weeks, and cost per sustained response in 16-week responders over 52 weeks from the perspective of the Brazilian Unified Health System (SUS).

METHODS: A 52-week decision-tree model reflecting response to treatment, defined as PASI reduction of <50%, 50%-74%, 75%-89%, and ≥90%. Sustained response was defined as response (PASI≥75) at 16 weeks and maintained at week 52. Non-responders and patients that discontinued treatment due to other reasons (e.g. adverse events, dropouts) were switched to standard of care. Clinical data inputs of PASI distribution at 4, 8, 12, 16 and 52 weeks were derived from the mixed treatment comparison comparing the biologics to placebo. Drug costs were estimated using the public price approved by Ministry of Health and the number of doses required for 52 weeks. Sensitivity analysis was performed to evaluate the impact of including 20% discount on the comparator prices.

RESULTS: Secukinumab had the lowest cost per PASI ≥90 responder over 16 weeks (BRL 13,816) compared with adalimumab (BRL 19,313), ustekinumab (BRL 22,482), etanercept (BRL 27,931) and infliximab (BRL 31,475). Over 52 weeks, costs per PASI ≥90 responder ranged from BRL 31,949 (secukinumab) to BRL 62,414 (infliximab). Likewise, secukinumab had the lowest cost per sustained 52-week PASI ≥90 responder (BRL 17,244) compared with other biologic treatments (BRL 23,775 – BRL 38,562). Sensitivity analysis confirmed the base case results.

CONCLUSIONS: The cost per PASI ≥90 responder was consistently lower for secukinumab compared with other biologic treatments from SUS perspective.