A real-world economic analysis of biologic therapies for moderate-to-severe plaque psoriasis in Italy: results of the CANOVA observational longitudinal study

Abstract

Background Psoriasis is a chronic immune-mediated inflammatory skin disease which can also involve joints. It is often associated with burdensome comorbidities which negatively impact prognosis and quality of life (QoL). Biologic agents have been shown to be effective in controlling disease progression, but their use is associated with higher costs compared with traditional systemic treatments. The economic analysis of the CANOVA (EffeCtiveness of biologic treAtmeNts for plaque psOriasis in Italy: an obserVAtional longitudinal study of real-life clinical practice) study aims to assess the costs and cost-effectiveness of biologics in a real-world context in Italy. Methods The annualised overall direct costs of moderate-to-severe plaque psoriasis management, the annualised cost of biologic drugs and the cost per responder in the Italian National Health System perspective were assessed. More specifically, the cost per response and cost per sustained response of the most prescribed biologic therapies for the treatment of moderate-to-severe plaque psoriasis within the CANOVA study were assessed using the Psoriasis Area Severity Index (PASI) at several score levels (75, 90 and 100%). Results The most frequently used biologic therapies for plaque psoriasis were secukinumab, ustekinumab, adalimumab originator, and ixekizumab. Cost of biologics was the driver of expenditure, accounting for about 98% of total costs. Adalimumab originator was the biologic with the lowest cost per responder ratio (range: €7848 - €31,378), followed by secukinumab (range: €9015 - €33,419). Ustekinumab (range: €11,689 – €39,280) and ixekizumab (range: €11,092 – €34,289) ranked respectively third and fourth, in terms of cost-effectiveness ratio. As concerns the cost per sustained response analysis, secukinumab showed the lowest value observed (€21,375) over the other options, because of its high response rate (86% vs. 60–80%), which was achieved early in time. Conclusion Biologic therapy is a valuable asset for the treatment of moderate-to-severe plaque psoriasis. Concomitant assessment of treatment costs against the expected therapeutic response over time can provide physicians and payers additional insights which can complement the traditional risk-benefit profile assessment and drive treatment decisions.

Cost per Responder Analysis of Secukinumab versus Adalimumab in the Treatment of Psoriatic Disease

“…Furthermore, a 2-year German payer perspective analysis that assessed the impact of placing secukinumab in psoriasis treatment sequencing with adalimumab, etanercept, infliximab, and ustekinumab found that using secukinumab as first-line biologic treatment was cost effective compared with initiating other biologic agents [ 29 ]. Conflicting findings were reported in a recent Italian cost per responder model based on the CANOVA (EffeCtiveness of biologic treAtmeNts for plaque psOriasis in Italy: an obserVAtional longitudinal study of real-life clinical practice) real-world study [ 30 , 31 ]. In that study, the costs per PASI 75/90/100 responder at 52 weeks were higher for secukinumab than adalimumab originator: €19,932 vs. €18,491, €23,978 vs. €22,755 and €33,419 vs. €31,378 respectively [ 31 ].…”

“…Conflicting findings were reported in a recent Italian cost per responder model based on the CANOVA (EffeCtiveness of biologic treAtmeNts for plaque psOriasis in Italy: an obserVAtional longitudinal study of real-life clinical practice) real-world study [ 30 , 31 ]. In that study, the costs per PASI 75/90/100 responder at 52 weeks were higher for secukinumab than adalimumab originator: €19,932 vs. €18,491, €23,978 vs. €22,755 and €33,419 vs. €31,378 respectively [ 31 ]. However, the number of patients on secukinumab ( n = 274) and adalimumab ( n = 87) were unbalanced [ 31 ].…”

“…In that study, the costs per PASI 75/90/100 responder at 52 weeks were higher for secukinumab than adalimumab originator: €19,932 vs. €18,491, €23,978 vs. €22,755 and €33,419 vs. €31,378 respectively [ 31 ]. However, the number of patients on secukinumab ( n = 274) and adalimumab ( n = 87) were unbalanced [ 31 ]. Further pharmacoeconomic studies based on larger real-world samples are needed to draw definite conclusions.…”

Patient Preference for Biologic Treatments of Psoriasis in the Chinese Setting

“…28 Italian studies on biologics for psoriasis included the cost attribute and illustrated that treatment costs and expected therapeutic response concurrently can provide valuable insights which complement and improve the traditional risk-benefit profile and drive treatment decisions. 29 , 30 Probably this depends on different health systems and medicine reimbursement policies in Europe. However, in the process of choosing treatment strategies, medical expenditure has gradually become an important factor for patients in the context of China.…”

Methotrexate in the therapeutic pathway of patients with psoriasis. Analysis of clinical practice data and comparison with guidelines

“…The costs analysis, subject of a recent multicentre observational study, 6 also deserves some reflection. In order to verify how better prescribing of Methotrexate, as expected by the Guidelines, can have an economic impact on the National Health Service, a Budget Impact study was recently conducted, showing that increasing the use of Methotrexate by 50% (from 22.05% to 33.08%) can reduce the overall costs of patient management.…”