Effect of Prior Biologic Use on Cost-Effectiveness of Brodalumab vs. Ustekinumab for Treatment of Moderate-to-Severe Psoriasis in the United States

Abstract

Introduction: Clinical trials have shown brodalumab to have better efficacy than ustekinumab for the treatment of moderate-to-severe psoriasis. An estimation of the cost-effectiveness of brodalumab vs. ustekinumab is warranted and may be useful for treatment decision-making processes, especially in the context of the cost considerations of the current US healthcare system. Therefore, we compared the cost-effectiveness of brodalumab with ustekinumab for treatment of moderate-to-severe psoriasis in biologic-naïve and biologic-experienced patients in the USA.

Methods: An Excel-based economic model was developed to estimate and compare total annual costs to health plans associated with treatment with brodalumab vs. ustekinumab per achievement of Psorasis Area and Severity Index (PASI) 75, 90, and 100 for patients with moderate-to-severe psoriasis.

Results: For treatment with brodalumab vs. ustekinumab, total annual treatment costs per PASI 75, 90, and 100 were $31,106, $57,776, and $163,069, respectively, lower for a patient naïve to prior biologic treatment; they were $40,535, $65,472, and $223,610, respectively, lower for a patient experienced with prior biologic treatment. In an additional analysis among patients with and without prior biologic failure, they were $52,822, $93,309, and $365,606, respectively, lower for a patient with failure and they were $31,660, $57,128, and $164,996, respectively, lower for a patient without failure.

Conclusion: Compared to ustekinumab, treatment with brodalumab was associated with better cost-effectiveness ratios for biologic-naïve and experienced-patients and also patients with and without prior biologic treatment failure. The greater cost-effectiveness of brodalumab was most prominent for biologic-experienced and prior biologic treatment failure patients.

Funding: Ortho Dermatologics.

Keywords: Biologics; Brodalumab; Cost-effectiveness; Psoriasis; Ustekinumab.

Fig. 1

Total annual health plan costs per PASI 75, 90, and 100 among a biologic-naïve and b biologic-experienced patients treated with brodalumab and ustekinumab. PASI Psoriasis Area Severity Index

Fig. 2

Total annual health plan costs per PASI 75, 90, and 100 among patients a with prior biologic failure and b without prior biologic failure and treated with brodalumab and ustekinumab. PASI Psoriasis Area Severity Index

Fig. 3

Univariate sensitivity analysis of the differences in total annual health plan costs per PASI 75 among a biologic-naïve and b biologic-experienced patients treated with ustekinumab vs. brodalumab. PASI Psoriasis Area Severity Index. PASI 75 efficacy rates were varied between the ranges of their respective 95% confidence intervals; incremental cost estimates were varied ± 30%. Non-responder medical cost: average annual total medical costs associated with PASI < 75. AE adverse event

Fig. 4

Multivariable sensitivity analysis of the differences in total annual health plan costs per PASI 75 among a biologic-naïve and b biologic-experienced patients treated with ustekinumab vs. brodalumab. PASI Psoriasis Area Severity Index

Fig. 5

Univariate sensitivity analysis of the differences in total annual health plan costs per PASI 75 among patients a with prior biologic failure and b without prior biologic failure and treated with ustekinumab vs. brodalumab. PASI Psoriasis Area Severity Index. PASI 75 efficacy rates were varied between the ranges of their respective 95% confidence intervals; incremental cost estimates were varied ± 30%. Non-responder medical cost: average annual total medical costs associated with PASI < 75. AE adverse event

Fig. 6

Multivariable sensitivity analysis of the differences in total annual health plan costs per PASI 75 among patients a with prior biologic failure and b without prior biologic failure and treated with ustekinumab vs. brodalumab. PASI Psoriasis Area Severity Index