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Vol. 110. Issue 7.
Pages 546-553 (September 2019)
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Vol. 110. Issue 7.
Pages 546-553 (September 2019)
Original Article
DOI: 10.1016/j.adengl.2019.07.001
A Cost-per-Number Needed to Treat Analysis Assessing the Efficiency of Biologic Drugs in Moderate to Severe Plaque Psoriasis
Evaluación de la eficiencia de los tratamientos biológicos en la psoriasis moderada a grave en España: análisis de coste por número necesario a tratar (NNT)
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M. Núñeza,
Corresponding author
nunez_mercedes@lilly.com

Corresponding author.
, T. Huetea, P. de la Cuevab, J.A. Sacristána, S. Hartzc, T. Dillaa
a Eli Lilly and Company, Madrid, Spain
b Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, Spain
c Eli Lilly and Company, Surrey, United Kingdom
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Statistics
Figures (2)
Tables (6)
Table 1. NNT per PASI Response Level With Placebo as the Comparator (CrI 2.5-97.5%).
Table 2. Official Manufacturer's Price (MP) for the Biologic Agents, Showing Applicable Discounts, Number of Pens or Vials per Pack, and Dose per Pen or Vial.
Table 3. Dosage, Number of Injections, and Cost per Patient for the First Year of Treatment.
Table 4. Data on Actual Response Used in Sensitivity Analysis, With Number of Injections During the Assessment Period and Cost per Patient.
Table 5. Cost per NNT in the First Year of Treatment.
Table 6. Cost per NNT During the Treatment Response Assessment Period.
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Abstract
Background and objectives

Psoriasis is a chronic inflammatory skin disease with an estimated prevalence in Spain of 2.3% of the population. Approximately 30% of patients have moderate-to-severe forms. Treatment with biologic agents is proving to be a step forward in the management of the disease, although these treatments are very expensive. The objective of this study was to determine the efficiency, in terms of cost per number needed to treat (NNT), of the biologic drugs available in Spain for the treatment of moderate to severe plaque psoriasis.

Methods

NNT data were obtained from a network meta-analysis that included all randomized clinical trials of biologic drugs sold in Spain. The cost of each treatment was calculated based on the approved dosage for the first year of treatment, as indicated in the Summary of Product Characteristics. These data were used to calculate the cost per NNT of the drugs for various PASI scores (75, 90, and 100). A sensitivity analysis was performed taking into consideration only the PASI-response measurement time (after 10, 12, or 16 weeks, depending on the drug).

Results

The order of efficiency, from most to least efficient, in the case of a PASI 75 response was ixekizumab > ustekinumab 45mg > ustekinumab 90mg > secukinumab > infliximab > etanercept > adalimumab. The order for PASI 90 was ixekizumab >secukinumab >ustekinumab 45mg > ustekinumab 90mg > infliximab > adalimumab > etanercept. The order for PASI 100 was ixekizumab > secukinumab > infliximab > ustekinumab 90mg > ustekinumab 45mg > adalimumab > etanercept. The sensitivity analysis showed some changes in the order, depending on the response-assessment period.

Conclusions

The findings show a link between the efficacy of the biologic therapies available in Spain for the treatment of moderate-to-severe plaque psoriasis and their efficiency. Ixekizumab had the lowest cost per NNT for all PASI-response scores (75, 90, and 100) during the first year of treatment.

Keywords:
Biologic therapy
Effectiveness
Psoriasis Area and Severity Index
Induction
Cost-effectiveness
Resumen
Antecedentes y objetivos

La psoriasis es una enfermedad inflamatoria crónica de la piel cuya prevalencia en España se estima en el 2,3% de la población y en la que alrededor del 30% de los pacientes tienen formas moderadas a graves. El tratamiento con agentes biológicos está suponiendo un avance en el manejo de la enfermedad, aunque también representa un reto económico. El objetivo de este estudio es determinar la eficiencia, en términos de coste por número necesario a tratar (NNT), de las terapias biológicas disponibles en España para el tratamiento de la psoriasis en placas moderada a grave.

Métodos

Los datos de NNT se obtuvieron de un metaanálisis en red que incluía todos los ensayos clínicos aleatorizados con medicamentos biológicos comercializados en España. Los costes de cada terapia se calcularon según las posologías aprobadas en las fichas técnicas para el primer año de tratamiento. A partir de estos datos se calculó el coste por NNT de los fármacos para los distintos niveles de PASI (75, 90 y 100). Se realizó un análisis de sensibilidad considerando solamente el periodo de medición de la respuesta PASI (de 10 a 16 semanas) según el tratamiento.

Resultados

Para la respuesta PASI 75, el orden de terapias de mayor a menor eficiencia es ixekizumab > ustekinumab 45mg > ustekinumab 90mg > secukinumab > infliximab > etanercept > adalimumab. Para la respuesta PASI 90, el orden es ixekizumab > secukinumab > ustekinumab 45mg > ustekinumab 90mg > infliximab > adalimumab > etanercept. Para la respuesta PASI 100 el orden es ixekizumab > secukinumab > infliximab > ustekinumab 90mg > ustekinumab 45mg > adalimumab > etanercept. El análisis de sensibilidad mostró algún cambio en el orden de las secuencias para el periodo de evaluación de la respuesta.

Conclusiones

Este análisis muestra una relación entre la eficacia de los tratamientos biológicos disponibles en España para el tratamiento de la psoriasis en placas moderada a grave y su eficiencia, siendo ixekizumab el que mostró un menor coste por NNT en todos los niveles de respuesta PASI alcanzados (75, 90 y 100) para el primer año de tratamiento.

Palabras clave:
Terapia biológica
Efectividad
Psoriasis Area and Severity Index
Inducción
Coste-efectividad

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