Cost-effectiveness of apremilast in moderate to severe psoriasis in the United Kingdom

Abstract

Purpose: Apremilast, an oral phosphodiesterase-4 inhibitor, is effective and well tolerated in the treatment of moderate-to-severe psoriasis. The cost-effectiveness of introducing apremilast before biologics was assessed from a UK payer perspective. Materials and methods: A 10-year Markov cohort model was developed to compare alternative treatment sequences: (1) apremilast followed by adalimumab and etanercept and (2) adalimumab followed by etanercept. Non-responders moved to the next treatment line, and patients for whom etanercept therapy failed continued on best supportive care (BSC) in both sequences. Response was defined as a ≥ 75% reduction in Psoriasis Area and Severity Index score (PASI-75) at the end of the trial periods (12‒16 weeks). A network meta-analysis provided efficacy inputs. Results: As a treatment-extension strategy, apremilast had an incremental cost-effectiveness ratio of £20,593 per quality-adjusted life-year gained versus the comparator sequence. PASI-75 was sustained for 0.73 additional years, and the total time on biologics and BSC was reduced by 0.44 and 1.01 years, respectively. These results were consistent with findings from sensitivity and scenario analyses. Conclusions: Apremilast, an oral treatment option for the treatment of moderate-to-severe plaque psoriasis, is cost-effective from a UK payer perspective when administered before biologics based on assumptions detailed within this analysis.

Keywords

• cost-effectiveness analysis
• psoriasis
• apremilast
• tnf-α inhibitors