OBJECTIVES: Systemic therapy with biologic agents is the most effective means of treating moderate-to-severe plaque psoriasis but comes with a significant economic burden. The purpose of this study was to compare the cost per responder (CPR) of brodalumab relative to ustekinumab in achieving 75%, 90%, and 100% reductions in the Psoriasis Area and Severity Index (PASI) score at 12 and 52 weeks.

METHODS: Phase III, double-blind, head-to-head studies AMAGINE-2 and AMAGINE-3 analyzed the efficacy and safety of brodalumab relative to both placebo and ustekinumab in patients with moderate-to-severe plaque psoriasis. Data from AMAGINE-2 and AMAGINE-3 was used to calculate the CPR for the achievement of PASI 75, 90, and 100. The costs considered were drug acquisition costs. Treatment costs were calculated using the proposed unit price for brodalumab, the confirmed unit price for ustekinumab (Ontario Drug Benefit Formulary) and each drug’s suggested dosing regimen as per the Canadian product monograph. Analyses were conducted from 12-week (induction phase) and 52-week (induction-maintenance phases) PASI responses.

RESULTS: The CPR for brodalumab was lower than ustekinumab for all endpoints (PASI 75, 90 and 100) in both trials for 12 and 52 weeks. In AMAGINE-2, the CPR for brodalumab at 12 weeks was $6,000, $7,371 and $11,727 (PASI 75, 90 and 100 respectively) compared to $13,123, $19,545 and $41,756 for ustekinumab. The CPR from AMAGINE-3 at 12 weeks was $6,071, $7,478, and $13,946 for brodalumab compared to $13,313, $19,138 and $48,349 for ustekinumab. In AMAGINE-2 the CPR for brodalumab at 52 weeks was $6,450, $6,880 and $9,214 compared to $14,817, $19,138, and $30,621 for ustekinumab. The CPR from AMAGINE-3 at 52 weeks was $6,450, $7,068 and $9,736 for brodalumab compared to $14,581, $18,373 and $31,677 for ustekinumab.

CONCLUSIONS: This analysis provides evidence for significant cost-effectiveness of brodalumab relative to ustekinumab in treating moderate-to-severe plaque psoriasis.