Feldman Steven R, Rastogi Shipra, Lin Jay
Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Ortho Dermatologics, Bridgewater, NJ, USA.
Dermatol Ther (Heidelb). 2018 Sep;8(3):441-453. doi: 10.1007/s13555-018-0251-4. Epub 2018 Jul 13.
Clinical trials have shown brodalumab to have better efficacy than ustekinumab for the treatment of moderate-to-severe psoriasis. An estimation of the cost-effectiveness of brodalumab vs. ustekinumab is warranted and may be useful for treatment decision-making processes, especially in the context of the cost considerations of the current US healthcare system. Therefore, we compared the cost-effectiveness of brodalumab with ustekinumab for treatment of moderate-to-severe psoriasis in biologic-naïve and biologic-experienced patients in the USA.
An Excel-based economic model was developed to estimate and compare total annual costs to health plans associated with treatment with brodalumab vs. ustekinumab per achievement of Psorasis Area and Severity Index (PASI) 75, 90, and 100 for patients with moderate-to-severe psoriasis.
For treatment with brodalumab vs. ustekinumab, total annual treatment costs per PASI 75, 90, and 100 were $31,106, $57,776, and $163,069, respectively, lower for a patient naïve to prior biologic treatment; they were $40,535, $65,472, and $223,610, respectively, lower for a patient experienced with prior biologic treatment. In an additional analysis among patients with and without prior biologic failure, they were $52,822, $93,309, and $365,606, respectively, lower for a patient with failure and they were $31,660, $57,128, and $164,996, respectively, lower for a patient without failure.
Compared to ustekinumab, treatment with brodalumab was associated with better cost-effectiveness ratios for biologic-naïve and experienced-patients and also patients with and without prior biologic treatment failure. The greater cost-effectiveness of brodalumab was most prominent for biologic-experienced and prior biologic treatment failure patients.
Ortho Dermatologics.
临床试验表明，在治疗中度至重度银屑病方面，布罗达单抗的疗效优于优特克单抗。有必要评估布罗达单抗与优特克单抗的成本效益，这可能有助于治疗决策过程，特别是在美国当前医疗保健系统的成本考量背景下。因此，我们比较了在美国初治生物制剂和有生物制剂治疗经验的患者中，布罗达单抗与优特克单抗治疗中度至重度银屑病的成本效益。
开发了一个基于Excel的经济模型，以估计和比较中度至重度银屑病患者每实现银屑病面积和严重程度指数（PASI）75、90和100，使用布罗达单抗与优特克单抗治疗相关的健康计划年度总成本。
对于使用布罗达单抗与优特克单抗治疗，每实现PASI 75、90和100的年度总治疗成本，在既往未接受过生物治疗的患者中分别为31,106美元、57,776美元和163,069美元，成本更低；在有生物治疗经验的患者中分别为40,535美元、65,472美元和223,610美元，成本更低。在另一项对有或无既往生物治疗失败患者的分析中，有失败经历的患者每实现PASI 75、90和100的年度总治疗成本分别为52,822美元、93,309美元和365,606美元，成本更低；无失败经历的患者分别为31,660美元、57,128美元和164,996美元，成本更低。
与优特克单抗相比，布罗达单抗治疗在初治生物制剂和有生物制剂治疗经验的患者以及有或无既往生物治疗失败的患者中，成本效益比更高。布罗达单抗更高的成本效益在有生物治疗经验和既往生物治疗失败的患者中最为显著。
奥多皮肤科公司。
