OBJECTIVES: To estimate the cost per responder (CPR) of currently approved biologic and subsequent entry biologic (SEB) agents in achieving reductions in the Psoriasis Area and Severity Index (PASI) score at the end of the induction period of therapy for adult patients with moderate-to-severe plaque psoriasis in Canada

METHODS: A literature review identified a published network meta-analysis evaluating relative effects for improvement from baseline (PASI 75/90/100) across treatments at the end of the induction period (10 to16 weeks). The CPR was estimated as the drug acquisition costs during the induction period multiplied by the number needed to treat (NNT) for achieving PASI 75, 90, or 100 for the following treatments: adalimumab (innovator and SEB), brodalumab, bimekizumab, certolizumab pegol, etanercept (innovator and SEB), guselkumab, infliximab (innovator and SEB), ixekizumab, risankizumab, secukinumab, tildrakizumab, ustekinumab (innovator and SEB). Canadian costs of treatments were estimated based on Health Canada approved regimens and Ontario wholesale unit prices obtained from the DeltaPA IQVIA database in June 2024. The primary analysis was the CPR for PASI 100, with PASI 75 and 90 as secondary analyses. Sensitivity analysis was performed from the perspective of provincial public drug plans, using available unit prices from respective provincial formularies.

RESULTS: The PASI 100 CPR were as follows: brodalumab $11,868; adalimumab SEB $27,240; guselkumab $28,272; bimekizumab $28,275; ustekinumab SEB $31,527; infliximab SEB $31,577-33,626; risankizumab $33,459; ixekizumab $39,541; secukinumab $40,668, adalimumab innovator $45,899; ustekinumab innovator $52,546; certolizumab 200 $59,914; infliximab innovator $63,253; certolizumab 400 $74,746; tildrakizumab $75,111; etanercept SEB $95,058-$96,998; etanercept innovator $163,401. Brodalumab and etanercept innovator also represented the lowest and highest CPR for PASI 75 and 90 respectively.

CONCLUSIONS: These results demonstrate that brodalumab has the lowest induction CPR across all PASI outcomes compared to other biologic therapies, including SEB therapies, thus providing the best value for money for patients, prescribers, and payers.