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Apremilast for the Treatment of Moderate to Severe Plaque Psoriasis: A Critique of the Evidence

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Abstract

As part of the National Institute for Health and Care Excellence’s (NICE) single technology appraisal (STA) process, apremilast was assessed to determine the clinical and cost effectiveness of its use in the treatment of moderate to severe plaque psoriasis in two patient populations, differentiated by the severity of the patient’s Psoriasis Area Severity Index (PASI) score. The Centre for Reviews and Dissemination (CRD) and the Centre for Health Economics (CHE) Technology Appraisal Group at the University of York was commissioned to act as the evidence review group (ERG). This article provides a summary of the company’s submission, the ERG report and NICE’s subsequent guidance. In the company’s initial submission, a sequence of treatments including apremilast was found to be both more effective and cheaper than a comparator sequence without it in both populations considered. However, this result was found to be highly sensitive to a series of assumptions made by the company, primarily reflecting the costs of best supportive care once no further treatments are available, and the source of utility estimates. A re-estimation of the cost effectiveness of apremilast by the ERG suggested that the apremilast sequence in the two populations was more effective, but due to high additional costs was not indicative of a cost-effective use of NHS resources. As such, in the final appraisal decision NICE concluded that apremilast was not cost effective in either population.

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Notes

  1. Subsequently, secukinumab (Cosentyx®) has been approved by NICE [11].

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Acknowledgments

We would like to thank Dr Phil Hampton, Consultant Dermatologist at the Newcastle upon Tyne Hospitals NHS Foundation Trust, for clinical advice throughout the project. We would also like to thank Dr. Mark Simmonds, Research Fellow, Centre for Reviews and Dissemination (CRD), for statistical advice, Melissa Harden, Information Specialist, CRD, for constructing the search strategies, and Huiqin Yang, Research Fellow, CRD, who assisted with the clinical effectiveness critique. This report was commissioned by the NIHR HTA (National Institute for Health Research Health Technology Assessment) Programme as project number 13/168/01. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of NICE (National Institute for Health and Care Excellence) or the Department of Health. The authors (Sebastian Hinde, Ros Wade, Stephen Palmer, Nerys Woolacott and Eldon Spackman) have no conflicts of interest that are directly relevant to the content of this summary.

Author contributions

Sebastian Hinde acts as the guarantor for the paper. Sebastian Hinde and Eldon Spackman wrote the economics section of the paper. Ros Wade wrote the clinical effectiveness sections. Stephen Palmer and Nerys Woolacott managed the economics and clinical effectiveness parts of the project and reviewed and commented on the paper.

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Authors and Affiliations

  1. Centre for Health Economics (CHE), University of York, York, YO10 5DD, UK

    Sebastian Hinde, Stephen Palmer & Eldon Spackman

  2. Centre for Reviews and Dissemination (CRD), University of York, York, UK

    Ros Wade & Nerys Woolacott

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  1. Sebastian Hinde
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  2. Ros Wade
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  3. Stephen Palmer
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  4. Nerys Woolacott
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  5. Eldon Spackman
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Correspondence to Sebastian Hinde.

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Hinde, S., Wade, R., Palmer, S. et al. Apremilast for the Treatment of Moderate to Severe Plaque Psoriasis: A Critique of the Evidence. PharmacoEconomics 34, 587–596 (2016). https://doi.org/10.1007/s40273-016-0382-3

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