Biologic treatment sequences for plaque psoriasis: a cost-utility analysis based on 10 years of Dutch real-world evidence from BioCAPTURE

Abstract

Background

Treatment with biologics may be indicated for patients with moderate to severe plaque psoriasis, but comparative evidence on cost-effectiveness is limited. Switching of biologics is common, but it is unclear what the effect is of differences in sequences of biologics.

Objective

Evaluate the cost-effectiveness of different biologic treatment sequences for psoriasis based on real-world evidence.

Methods

A sequence model was developed to evaluate the costs and health effects of three consecutive lines of biologic treatments (for example adalimumab-etanercept-ustekinumab versus etanercept-ustekinumab-adalimumab) over a 10-year time horizon in the Netherlands. The model was populated with data from the Dutch BioCAPTURE registry and scientific literature. Analyses were conducted of cost per quality-adjusted life year (QALY) and uncertainty was addressed by probabilistic as well as scenario analyses.

Results

Treatment of psoriasis with biologics for a 10-year period was estimated to be associated with a cost of € 141,962 to € 148,442 per patient depending on the treatment sequence used. Cumulative health effects ranged from 7.79 to 8.03 QALYs. Starting with adalimumab or ustekinumab seems favourable concerning cost and utilities compared to strategies starting with etanercept, though credible intervals were partly overlapping.

Conclusions

The order in which biologics are used influences treatment cost-effectiveness, both in terms of costs and health effects. Initiation of a biologic treatment sequence for psoriasis may best be done with adalimumab or ustekinumab; etanercept seems less optimal from a health-economic perspective.

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