Pharmacoeconomic evaluation of treatment options for patients with moderate to severe psoriasis and resistance to basic systemic therapy

Aim

Pharmacoeconomic analysis of the biological agents and apremilast for the treatment of patients with moderate to severe psoriasis from the Russian health care system perspective.

Material and methods

The "decision tree" model was constructed to estimate treatment outcomes and costs according to the therapy regimens. Each regimen started with one of the compared drugs for the treatment of psoriasis (first line). Inside each regimen, a switch to the second and third line drugs was modelled. The medicines for the second and third lines of treatment were chosen in accordance with the practice described in the publications. We compared etanercept, adalimumab, infliximab (original and biosimilar), ustekinumab, secukinumab, and apremilast. The duration of treatment with each drug was based on the data from the international registries, while effectiveness of therapy was evaluated using meta-analysis. The modeling horizon was three years and allowed to compare the costs for each regimen taking into account the duration of treatment with each drug in the real-life clinical practice. The cost-effectiveness analysis and the sensitivity analysis were conducted.

Results

The regiment of treatment starting with etanercept was associated with the lowest costs for 3-year therapy per patient, while the regimen of treatment starting with secukinumab had the best "cost-effectiveness" ratio. The sensitivity analysis demonstrated the stability of the results obtained with a reduction in the prices of comparator products up to 5%.

Conclusion

From the Russian healthcare perspective, secukinumab is the most rational drug for the initial therapy of moderate to severe psoriasis in patients who do not respond to standard systemic therapy.

Key words

Psoriasis, pharmacoeconomics, cost-effectiveness analysis, etanercept, adalimumab, infliximab, ustekinumab, secukinumab, apremilast.