OBJECTIVES: Cost-effectiveness analysis of biologics for the treatment of moderate-severe psoriasis in Spain.

METHODS: Cost analysis per responder (CPR) to achieve PASI100 for IL-17 therapies (brodalumab, secukinumab, ixezikumab), IL-12/23 therapies (ustekinumab), and IL-23 therapies (guselkumab, tildrakizumab, risankizumab) vs. placebo. Efficiency was based on achievement of PASI100 at 16 weeks (short-term) and 52 weeks (long-term), obtained from Network Meta-Analysis; 2020 ex-factory prices+VAT were obtained from BotPlus. Robustness was checked by a sensibility analysis.

RESULTS: Brodalumab showed higher probability to achieve PASI100, PASI90, and PASI75 after one year. Short-term: brodalumab is among the treatments with the lowest number needed to treat (NNT) (2,56-2,60) together with ixekizumab (2,49-2,54), and risankizumab (2,48-2,54); however, it is the most efficient drug with a CPR of 11.638-11.808€. Long-term: brodalumab has similar results to risankizumab, NNT=1,89 vs 1,71, but CPR for brodalumab is much lower 25.733€ vs. 31.466€. With a scenario of 20% reduction of notified prices of brodalumab, the rest of the treatments would need discounts 49-91% for being as cost-effective in the short-term and 35-53% for the long-term. Considering 20% reduction on the prices, brodalumab is the most efficient drug within the IL-17 group (short-term: 9.379€/brodalumab vs 20.508€/secukinumab and 15.632€/ixekizumab; long-term: 20.586€/brodalumab vs 34.928€/secukinumab and 29.170€/ixekizumab).

CONCLUSIONS: Brodalumab appears to be a cost-effective alternative versus the current biologic treatments for moderate-severe psoriasis in Spain, being the most cost-efficient alternative within the IL-17 therapeutic group.