OBJECTIVES: To evaluate the budget impact of introducing tildrakizumab, an interleukin–23 inhibitor, as first-line treatment for moderate-to-severe plaque psoriasis from a US health plan’s perspective, and its comparative cost per month with a Psoriasis Area Severity Index (PASI) 75 response.
METHODS: The budget impact of introducing tildrakizumab by a hypothetical US health plan with 1 million members over 5 years was estimated, assuming 1% annual uptake of tildrakizumab. Incremental annual health plan and per-member-per-year (PMPY) costs were estimated. A Markov model with 5 health states (PASI 0-49, 50-74, 75-89, 90-100; death) assessed the incremental cost per month with a PASI ³75 response for each first-line treatment compared with a mix of topical therapy, phototherapy, or other systemic therapy. Responders (PASI ³75) maintained current treatment. Non-responders received either a mix of topical therapy, phototherapy, other systemic therapy, or a second-line therapy. Inputs for both models were obtained from published literature, clinical trials, and prescription data. Both models included adalimumab, apremilast, brodalumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab. All costs were in $2018.
RESULTS: Tildrakizumab had lower annual costs than secukinumab, etanercept, adalimumab, guselkumab, ustekinumab, or ixekizumab. In a health plan of 1 million members with 1,048 patients receiving biologics or apremilast, introducing tildrakizumab resulted in a 5-year cumulative reduction of $351,147 in health plan costs and $0.14 in PMPY costs. The incremental costs per month with a PASI ³75 response were: brodalumab, $3,516; infliximab, $3,665; apremilast, $4,365; tildrakizumab, $4,816; secukinumab, $4,972; guselkumab, $5,351; adalimumab, $5,369; ustekinumab, $5,485; ixekizumab, $5,495; and etanercept, $5,771.
CONCLUSIONS: Introduction of tildrakizumab has the potential to reduce the overall costs of psoriasis treatment for a US health plan. Tildrakizumab as a first-line treatment is among the most cost-effective therapies, and is more cost‑effective than secukinumab, guselkumab, adalimumab, ustekinumab, ixekizumab, or etanercept.
