Cost-efficacy of biologic therapies for moderate to severe psoriasis from the perspective of the taiwanese healthcare system

Biologic therapies are more effective than conventional therapies in the treatment of psoriasis, but they are also more costly. Objectives: The aim of this study was to compare the cost-efficacy of etanercept, adalimumab, and ustekinumab therapies in the treatment of moderate to severe psoriasis in a Taiwanese setting. Methods: We conducted a meta-analysis of randomized, placebo-controlled trials to calculate the incremental efficacy of etanercept, adalimumab, and ustekinumab, respectively, in affecting a reduction of ≥75% in score on the Psoriasis Area and Severity Index (PASI 75). The base, best case, and worst case incremental cost-effectiveness ratios (ICERs) for one subject to achieve PASI 75 were calculated for the purposes of economic analysis. Results: One-year ICERs per PASI 75 responder were US$ 39,709 (best scenario US$ 36,400; worst scenario US$ 43,680), US$ 23,711 (best scenario US$ 22,633; worst scenario US$ 25,319), and US$ 26,329 (best scenario US$ 24,780; worst scenario US$ 27,623) for etanercept, adalimumab, and ustekinumab, respectively. Two year ICERs per PASI 75 responder were US$ 71,973 (best scenario US$ 65,975; worst scenario US$ 79,170), US$ 62,665 (best scenario US$ 59,817; worst scenario US$ 66,914), and US$ 52,657 (best scenario US$ 49,560; worst scenario US$ 55,427) for etanercept, adalimumab, and ustekinumab, respectively. Conclusions: In a Taiwanese setting, adalimumab and ustekinumab had lower 1-year costs per PASI 75 responder than etanercept, and ustekinumab had the lowest 2-year cost per PASI 75 responder.