Budget impact analysis of biologic treatments of moderate to severe psoriasis in the Brazilian Public Healthcare System: a tool for decision-makers

Abstract

Introduction: The public Brazilian healthcare system (SUS) does not reimburse biologics for the treatment of moderate to severe psoriasis. These treatments, however, are reimbursed for a variety of other illnesses including Crohn’s disease, psoriatic arthritis, and rheumatoid arthritis. As a result, psoriatic patients rely on court orders for access to biologic treatment, without clear criteria from SUS policy makers. Furthermore, there is an ample body of evidence, both clinical and economical, which may guide SUS policy makers to decide whether or not to adopt biologics for the treatment of moderate to severe psoriasis. Objective: This article aims to provide budget impact estimates of reimbursing biologics for the treatment of moderate to severe psoriasis under the SUS. Methods: The estimates were drawn from a hypothetical cohort of 1.000 psoriatic patients, due to a lack of official estimates on the incidence and prevalence of the disease. Annual treatment costs were calculated based on the number of vials used, as defined in the label for each biologic, and from the price per vial. The prices of etanercept, adalimumab and infliximab were obtained from purchase disclosures by the Brazilian Ministry of Health. As ustekinumab, the latest biologic approved for psoriasis, has not yet been purchased by that Ministry, its list price after deducting the mandatory discount for government sales (22.85%) was considered. Patient distribution for each biologic treatment was based on the total government sales with each biologic in 2009, adjusting for psoriasis. Results: The average treatment cost per patient was R$ 40.523,60 for treatment year, considering the biologics already reimbursed in the SUS. Results also show that the budget impact of adopting ustequinumabe, the latest biologic approved for the treatment of psoriasis, reduces the average treatment cost per patient to R$ 24.834,52 a year. In total, the reimbursement of ustequinumabe results in savings to the SUS of R$ 15,69 million a year for a cohort of 1.000 patients. Conclusion: The reimbursement of ustekinumab for the treatment of moderate to severe psoriasis in the public Brazilian healthcare system has a positive budgetary impact compared to the other biologics, generating significant savings given a specific patient cohort.