OBJECTIVES: To assess the cost-per-responder of biologic therapies available in Brazil to treat moderate-to-severe plaque psoriasis (PsO) using as outcomes a reduction of 75%, 90%, and 100% in Psoriasis Area and Severity Index (PASI 75/90/100).

METHODS: Comparative cost-effectiveness of risankizumab, adalimumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab was evaluated for the Brazilian private healthcare system using a cost-per-responder analysis based on PASI score reduction. Efficacy data was extracted from a previously published network meta-analysis (NMA). Cost-per-responder included cost of drug acquisition (ex-factory price) in 3 time horizons (primary response period [12-16 weeks], 1-year and 2-years) multiplied by the number needed to treat (NNT) for each PASI endpoint.

RESULTS: Considering NMA base case, the lowest cost-per-responder considering primary response period was observed for risankizumab for PASI 75, 90, and 100 (BRL40,106; 47,729; 83,496, respectively), followed by guselkumab (BRL41,338, 50,906; 94,520, respectively). Overall, the differences in the mean cost-per-responder between risankizumab and other biologic drugs increased with higher PASI reduction. Highest cost-per-responder was observed for infliximab for PASI 75 (BRL64,096) and etanercept for PASI 90 and PASI 100 (BRL131,674; 539,540, respectively). In 1-year, cost-per-responder using PASI 75, 90 and 100 was lowest for risankizumab (BRL92,341; 103,472; 140,909, respectively), followed by ixekizumab (BRL107,329; 128,395; 199,155, respectively). In 2-years time horizon, cost-per-responder using PASI 75, 90 and 100 was lowest for risankizumab (BRL166,214; 186,250; 253,636, respectively), followed by ixekizumab (BRL189,404; 226,579; 351,449, respectively). Using data from NMA sensitivity analysis, risankizumab presented the lowest cost-per-responder for PASI 100 (BRL269,432) whereas guselkumab and risankizumab presented the lowest cost-per-responder for PASI 75 (BRL165,269; 168,059, respectively) and PASI 90 (BRL190,540; 190,706, respectively) in 2-years.

CONCLUSIONS: Among the evaluated biologic therapies, risankizumab was associated with lowest cost-per-responder in all analyzed PASI outcomes, with more pronounced difference in higher PASI responses, considering Brazilian private healthcare system.