OBJECTIVES: Historically, topical therapies for the treatment of plaque psoriasis have had numerous limitations in terms of their efficacy, tolerability, and safety for chronic use and in sensitive areas of the body. Topical roflumilast cream, 0.3% was developed to fill this unmet need by providing a non-steroidal that is safe and effective for the treatment of chronic plaque psoriasis, including being the first indicated for the treatment of hard-to-treat intertriginous areas. A cost-utility model was developed to evaluate the cost-effectiveness of roflumilast cream relative to current topical treatment options for the treatment of plaque psoriasis from the Canadian societal perspective over a 5-year time horizon.

METHODS: A Markov state-transition cohort model was developed to assess the cost-effectiveness of roflumilast for treating patients with plaque psoriasis. The model followed patients through multiple lines of therapy across levels of severity. Comparator treatments included all topical treatments reimbursed by at least one public drug plan in Canada and were grouped by treatment type. Efficacy and utility inputs were derived from existing literature. Costs were estimated from data published by Canadian public health ministries. Analyses were conducted for the general plaque psoriasis population and those with intertriginous involvement.

RESULTS: Roflumilast had the lowest costs and highest quality-adjusted life-years (QALYs), dominating all other treatments in both analyses. Patients using roflumilast in the general population had $231 lower costs and 0.006 higher QALYs than the most cost-effective comparator treatment. In the intertriginous analysis, roflumilast was even more cost-effective, with $1,956 lower costs and 0.021 higher QALYs than the most cost-effective comparator, due to limited treatment options available to these patients.

CONCLUSIONS: Roflumilast is a cost-effective treatment for patients with plaque psoriasis, including intertriginous involvement, in Canada. Patients using roflumilast would improve their health-related quality of life, while also lowering costs from the Canadian societal perspective.