BACKGROUND: Tildrakizumab, a high-affinity, humanized, IgG1 κ, anti-interleukin–23 monoclonal antibody, recently received United States (U.S.) Food and Drug Administration approval for the treatment of moderate-to-severe plaque psoriasis. While many targeted immunomodulators are available, the affordability of tildrakizumab for U.S. health care payers has not been assessed.
OBJECTIVE: To evaluate the budget impact of introducing tildrakizumab for the treatment of moderate-to-severe plaque psoriasis from a U.S. health plan’s perspective.
METHODS: A budget-impact model was developed to estimate costs, before and after the adoption of tildrakizumab, over 5 years to a hypothetical U.S. health plan with 1 million covered lives. In addition to tildrakizumab, the model included adalimumab, brodalumab, etanercept, guselkumab, ixekizumab, secukinumab, ustekinumab, and apremilast. Psoriasis prevalence, treatment costs (acquisition, administration, and monitoring), and market shares were obtained from the published literature, clinical trials, and prescription data. New biologic patients and those switching from one biologic treatment to another required induction dosing, while existing biologic patients required maintenance dosing per product labels. The incremental annual health plan, per-member-per-year, and per-member-per-month costs were estimated in 2018 U.S. dollars, with an annual uptake of 1% for tildrakizumab over 5 years.
RESULTS: In a health plan of 1 million members with an estimated 1,048 patients receiving targeted immunomodulators, total annual health plan costs after introducing tildrakizumab increased $35,372 in year 1 but decreased $55,217, $82,826, $110,434, and $138,043 in years 2-5, respectively, resulting in a cumulative reduction of $351,147. The incremental budget impact was a 0.05% total cost increase in year 1 and cost reductions between 0.08% and 0.21% in years 2-5. The impact on total cost was largely due to drug-treatment costs. The incremental per-member-per-year costs were $0.04, $0.06, $0.08, $0.11, and $0.16 in years 1-5, resulting in negligible impact on per-member-per-month cost in years 1-2 and a reduction of $0.01 in years 3-5. Including adverse-event costs had minimal impact on the total costs, with a slightly increased cumulative reduction of $367,647 over 5 years.
CONCLUSIONS: Introduction of tildrakizumab with a 1% annual uptake over 5 years has the potential to reduce the cost of treating patients with moderate-to-severe plaque psoriasis for a U.S. health plan.
SPONSORSHIP: Sun Pharmaceutical Industries.
