Jia X, Zhao Y, Carrico J, Brodtkorb TH, Mendelsohn A, Lowry S, Feldman S, Armstrong A, Wu JJ. Comparative cost per time in response for tildrakizumab in U.S. patients with moderate-to-severe plaque psoriasis. Poster presented at the 2019 American Academy of Dermatology (AAD) Annual Meeting; March 1, 2019. Washington, DC. Previously presented at the 2018 Academy of Managed Care Pharmacy (AMCP) Nexus Conference.

BACKGROUND: The U.S. Food and Drug Administration recently approved tildrakizumab, a high-affinity, humanized, IgG1κ, anti-interleukin–23 monoclonal antibody for patients with moderate-to-severe plaque psoriasis. Understanding the comparative cost-effectiveness of tildrakizumab is important for health care payers and prescribers.

OBJECTIVES: To assess the comparative cost per month with a Psoriasis Area Severity Index (PASI) response for first-line tildrakizumab, adalimumab, apremilast, brodalumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab in treating moderate-to-severe plaque psoriasis from a U.S. health plan perspective.

METHODS: The 10-year cost-effectiveness analysis used a Markov model with five health states: four states based on PASI response (PASI 0-49, PASI 50-74, PASI 75-89, and PASI 90-100) and death. All patients received one of the treatments upon entering the model, respectively. Nonresponders, i.e., those who failed to achieve PASI 75 response, were withdrawn from their current treatment; 25% received either topical therapy, phototherapy, or other systemic therapy, and 75% received the basket of remaining comparators as a second-line therapy before receiving topical therapy, phototherapy, or other systemic therapy. Network meta-analysis of published clinical trial data provided PASI response rates. Total cumulative months in which a patient achieved at least a PASI 75 response was estimated. Total costs consisted of drug acquisition and administration, laboratory tests, and clinical visits.

RESULTS: Compared with topical therapy, phototherapy, or other systemic therapy, the incremental cost per month with PASI 75 was lowest for brodalumab ($3,516), infliximab ($3,665), and apremilast ($4,365), followed by tildrakizumab ($4,816), secukinumab ($4,972), guselkumab ($5,351), adalimumab ($5,369), ustekinumab ($5,485), ixekizumab ($5,495), and etanercept ($5,771). The position of tildrakizumab relative to the other treatments remained the same across multiple scenarios investigated.

CONCLUSIONS: Tildrakizumab is among the most cost-effective first-line therapies for treating moderate-to-severe plaque psoriasis and is more cost-effective than secukinumab, guselkumab, adalimumab, ustekinumab, ixekizumab, or etanercept.

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