Tildrakizumab More Cost-Effective Than Several Competitors in Treating Moderate to Severe Psoriasis

The monoclonal antibody tildrakizumab, sold by Sun Pharma as Ilumya, is more cost-effective for treatment of moderate-to-severe psoriasis than a half dozen competitors, including top-selling adalimumab (Humira), according to data presented this week at the Academy of Managed Care Pharmacy Nexus 2019, held in National Harbor, Maryland.

Authors led by Justin Carrico of RTI Health Solutions presented a poster comparing 9 different biologics and the oral drug apremilast (Otezla) in treatment of psoriasis; their anaylsis, “from a US health plan’s perspective,” involved both base cost and cost-effectiveness models that included adverse events.

The authors examined the costs 2 ways: first, they used a 5-year budget impact model, based on a health plan of 1 million members with psoriasis patients at the US average of 3.2%. Assuming 20% received 1 of the 10 treatments in the study, that meant 1048 would be treated.

Second, the authors used a 10-year cost effectiveness model based on assumptions about the patients who did not respond to treatment, as determined by the Psoriasis Area and Severity Index (PASI) score. The study assumed that 25% of these patients would receive topical therapy, phototherapy, or other oral therapy; 75% would receive another treatment from the first-line therapy group before topical or phototherapy would be pursued. The costs of managing adverse events was included; these included hospitalizations, nonmelanoma skin cancer, and other malignancies.

The authors concluded that tildrakizumab “is among the most cost-effective first-line therapies for treating moderate-to-severe plaque psoriasis and is more cost-effective than secukinumab, guselkumab, adalimumab, ixekizumab, ustekinumab, or etanercept.”

According to the findings, year 1 drug costs for tildrakizumab were $65,000; costs for adalimumab were $70,000; guselkumab, $75,000; secukinumab, ixekizumab, ustekinumab and etanercept were all $80,000 or higher. Apremilast year 1 costs were $40,000; infliximab and brodalumab, $45,000.

When comparing the incremental cost per month for PASI score of 75—and factoring in productivity gains—apremilast, infliximab, brodalumab, and tildrakizumab were each $5000 or less; the other drugs studied were more than $5000 per month.

Reference

Carrico J, Jia X, Zhao Y, et al. Cost-effectiveness and budget impact of tildrakizumab for the treatment of moderate-to-severe plaque psoriasis using 2019 drug costs. Presented at the Academy of Managed Care Pharmacy Nexus 2019, National Harbor, Maryland; October 31, 2019.