Carrico Justin, Zhao Yang, Jia Xiaoying, Brodtkorb Thor-Henrik, Mendelsohn Alan, Lowry Simon
RTI Health Solutions, Research Triangle Park, NC, USA.
Kyowa Kirin Pharmaceutical Development, Inc., 212 Carnegie Center Dr #400, Princeton, NJ, 08540, USA.
Pharmacoecon Open. 2020 Dec;4(4):669-677. doi: 10.1007/s41669-020-00208-9.
The aim of this study was to evaluate the budget impact of introducing tildrakizumab for moderate-to-severe plaque psoriasis from a US health plan perspective.
A budget impact model estimated costs before and after the adoption of tildrakizumab to a hypothetical US health plan with 1 million covered lives over 5 years. Additionally, the model included adalimumab, brodalumab, etanercept, guselkumab, ixekizumab, secukinumab, ustekinumab, and apremilast; biosimilars were not included. Model input data were obtained from the published literature, clinical trials, and prescription data. Market uptake for tildrakizumab was assumed as 1% annually over 5 years. Patients initiating or switching treatments required induction dosing; all others treated required maintenance dosing. The model compared the total annual costs for tildrakizumab versus treatment without tildrakizumab to calculate budget impact in 2018 US dollars. Scenarios exploring alternative assumptions for adverse events and market uptake rates were assessed, and a one-way sensitivity analysis was conducted.
Within a health plan of 1 million members with an estimated 1048 patients receiving biologics or apremilast for psoriasis, the total annual health plan cost after introducing tildrakizumab decreased by $5585, $137,025, $205,538, $274,051, and $342,563 in years 1-5, respectively, resulting in a cumulative reduction of $964,763 over 5 years. The impact on total cost was largely due to drug acquisition costs. The incremental per member per month (PMPM) cost reductions were negligible in year 1, $0.01 in year 2, $0.02 in years 3-4, and $0.03 in year 5. Scenario and sensitivity analyses confirmed the model robustness.
The introduction of tildrakizumab with a 1% annual uptake over 5 years has the potential to reduce the cost of treating patients with moderate-to-severe plaque psoriasis for a US health plan.
本研究旨在从美国医疗计划的角度评估引入替拉珠单抗治疗中重度斑块状银屑病的预算影响。
采用预算影响模型，对一个假设的覆盖100万人口的美国医疗计划在采用替拉珠单抗前后5年内的成本进行估算。此外，该模型纳入了阿达木单抗、布罗达单抗、依那西普、古塞库单抗、司库奇尤单抗、优特克单抗、ixekizumab和阿普斯特；未纳入生物类似药。模型输入数据来自已发表的文献、临床试验和处方数据。假设替拉珠单抗在5年内的市场占有率为每年1%。开始或转换治疗的患者需要诱导给药；所有其他接受治疗的患者需要维持给药。该模型比较了使用替拉珠单抗与不使用替拉珠单抗治疗的年度总成本，以计算2018年美元的预算影响。评估了探索不良事件和市场占有率替代假设的情景，并进行了单向敏感性分析。
在一个拥有100万成员的医疗计划中，估计有1048名患者接受生物制剂或阿普斯特治疗银屑病，引入替拉珠单抗后，第1 - 5年医疗计划的年度总成本分别降低了5585美元、137025美元、205538美元、274051美元和342563美元，5年累计降低964763美元。对总成本的影响主要归因于药品采购成本。第1年每位成员每月（PMPM）成本的增量降低可忽略不计，第2年为0.01美元，第3 - 4年为0.02美元，第5年为0.03美元。情景分析和敏感性分析证实了模型的稳健性。
在5年内每年以1%的占有率引入替拉珠单抗，有可能降低美国医疗计划中治疗中重度斑块状银屑病患者的成本。
