Cost-effectiveness analysis of biologics in the treatment of moderate to severe psoriasis in the private healthcare system of Brazil

Abstract

Objetive: to estimate the cost per responder of biologic treatment of moderate to severe psoriasis in the Brazilian private healthcare system. Methods: Four biologics are approved in Brazil for the treatment of moderate to severe psoriasis, adalimumab, etanercept, infliximab, and ustekinumab. Considering the on-label dosing, yearly treatment costs were calculated based on the official CMED price per vial. A recent metanalysis by Reich et al. was used to gather the probability of achieving a PASI 75 response for each treatment, considering the 95% confidence interval. To estimate the impact of biologic treatment of moderate to severe psoriasis, it was assumed a hypothetical budget of R$ 1 million. Results: Ustekinumab has the lowest treatment cost, even considering the higher incidence of tax, in both induction and maintenance years compared to the remaining biologics. Etanercept has the second lowest treatment cost (79% higher than ustekinumab), followed by adalimumab (90%) and infliximab (94%) in the maintenance year. Considering the probability of PASI 75 response, ustekinumab is the most cost-effective with a cost per PASI 75 response of R$ 44.362, followed by infliximab (R$ 80.802/PASI 75 response), adalimumab (R$ 107.008/PASI 75 response) and etanercept (R$ 114.251/PASI 75 response). Considering a budget of R$ 1 million, ustekinumab and infliximab result in a higher number of PASI 75 responders. Conclusion: Of all biologic treatments approved in Brazil for psoriasis, ustekinumab represents the least costly treatment option and the most cost-effective. Despite higher cost, infliximab is the second most cost-effective biologic followed by adalimumab and etanercept from a private payer perspective.