Cost per cumulative clinical benefit of biologic therapies for patients with plaque psoriasis: a systematic review

BACKGROUND: Measuring cumulative clinical treatment benefit over time captures speed and magnitude of effects. Assessing the cost biologics relative to their benefits versus a single point represents an alternative evaluate value given biologic used treat psoriasis. OBJECTIVE: To compare per in moderate severe psoriasis from network meta-analysis (NMA). METHODS: Biologics included analysis were ixekizumab, adalimumab, guselkumab, ustekinumab, secukinumab, risankizumab, certolizumab pegol. Psoriasis Area Severity Index (PASI) responses initial 16-week period obtained 31 articles. Cumulative for PASI 75, 90, 100 measured as area under curve (AUC) using trapezoidal method. Bayesian-based NMA modeled percent maximum AUC through week 16 (%Max_AUCW16). The estimates weeks converted total skin clearance threshold days achieved with each biologic. Cost was estimated by multiplying number doses (per FDA label) nationally representative discounted wholesale acquisition costs (WACs) divided %Max_AUCW16. primary WACs, including doses. Co-primary Sensitivity conducted WACs excluding administered at 16. RESULTS: Among available data 90 100, ranged 20.2% (certolizumab pegol) 47.0% (ixekizumab) 7.4% (adalimumab) 22.2% 100. first highest ixekizumab (53 25 days, respectively). In analysis, guselkumab had lowest (95% credible interval [CrI]; $99,742 [$89,941-$111,653]), followed ($108,906 [$95,928-$126,093]) adalimumab ($111,233 [$97,549-$129,022]) ($230,884 [$191,611-$291,115]), secukinumab ($238,945 [$204,029-$288,072]) risankizumab ($279,968 [$250,683-$316,872]) responses. co-primary CrI; $60,988 [$53,719-$70,612]), ($66,827 [$60,260-$74,807]) ($69,622 [$61,783-$79,786]) ($129,295 [$107,302-$163,024]), ($148,146 [$126,498-$178,605]) ($188,190 [$166,791-$215,969]) Conclusions: studied, demonstrated greatest benefit, maintaining period. DISCLOSURES: This study funded Eli Lilly Company (Indianapolis, IN). Blauvelt has served scientific adviser and/or investigator AbbVie, Aclaris, Almirall, Arena, Athenex, Boehringer Ingelheim, Bristol-Myers Squibb, Dermavant, Dermira, Company, Forte, Galderma, Incyte, Janssen, Leo, Novartis, Ortho, Pfizer, Rapt, Regeneron, Sandoz, Sanofi Genzyme, Sun Pharma, UCB Pharma paid speaker AbbVie. Burge, Zhu, Malatestinic, Brnabic, Guo, Janardhanan are employees shareholder Company.