Cost Effectiveness of Moderate to Severe Psoriasis Therapy with Etanercept and Ustekinumab in the United States
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Limited information is available on the cost effectiveness of ustekinumab and alternative biologic treatments in a United States (US) setting. Given the recent head-to-head clinical trial study of ustekinumab and etanercept, an economic model comparing the two treatments can be constructed. Etanercept and ustekinumab are indicated for the treatment of chronic moderate to severe plaque psoriasis in adult patients who are candidates for phototherapy or systemic therapy.
Clinical trials have evaluated the efficacy of ustekinumab, an anti-cytokine biologic, for the treatment of moderate to severe psoriasis. This study evaluated the cost effectiveness of ustekinumab compared with etanercept from a US societal perspective.
A Markov model was constructed to simulate the incremental cost per quality-adjusted life-year (QALY) gained every 12 weeks over a base-case 3-year time horizon. A hypothetical patient cohort was based on the characteristics of the phase III Active Comparator Psoriasis Trial (ACCEPT). The main outcome measures were costs and QALYs, which were estimated from the US societal perspective. Costs, utilities, treatment strategy, and resource use estimates were obtained from relevant literature. All costs were adjusted to 2011 US dollars. A 3 % annual discount rate was applied to costs and QALYs. Incremental cost-effectiveness ratios were in US dollars per QALY gained.
For the base-case 3-year time horizon, the incremental cost-effectiveness ratio comparing ustekinumab 90 mg with etanercept 50 mg was US$384,401 per QALY gained. Ustekinumab 45 mg dominates etanercept 50 mg for the same time horizon. These results were robust to sensitivity analyses involving treatment strategy, transition probabilities, valuing outcomes, and resource use and costs. The probabilistic sensitivity analysis suggests ustekinumab 90 mg has a minimal (4 %) chance of being cost effective compared with etanercept 50 mg at a willingness-to-pay threshold of US$150,000 per QALY improvement. For the same threshold, ustekinumab 45 mg has a high (88 %) chance of being cost effective compared with etanercept 50 mg.
Under typical US willingness-to-pay cutoffs, ustekinumab 90 mg is not cost effective compared with etanercept 50 mg therapy in moderate to severe psoriasis patients for the base-case 3-year time horizon. Ustekinumab 45 mg dominates etanercept 50 mg therapy for an equivalent patient psoriasis severity and time horizon.
Mr. Reginald Villacorta, and Drs. Joel Hay and Andrew Messali had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Villacorta, Hay, Messali. Acquisition of data: Villacorta. Analysis and interpretation of data: Villacorta, Hay, Messali. Drafting of the manuscript: Villacorta, Hay, Messali. Critical revision of the manuscript for important intellectual content: Villacorta, Hay, Messali. Statistical analysis: Villacorta, Hay, Messali.
Role of the Sponsors
No sponsors were involved in this study.
Statement on Financial Disclosure/Conflict of Interest
Mr. Villacorta was a part-time employee for Johnson & Johnson. Drs. Hay and Messali have no conflicts of interest to declare. Johnson & Johnson Pharmaceuticals did not sponsor this study, nor did they have any part in the preparation, design, analysis, review or interpretation of this study. The authors would like to thank the anonymous reviewers for their helpful comments.
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