Oral Treatment of Psoriasis & Cost: where does Apremilast (Otezla) stand ?

The cost efficacy of apremilast (Otezla) in patients with moderate to severe plaque psoriasis was assessed against 3 biologics: adalimumab, etanercept, and ustekinumab. Two methods were employed: the estimated cost to achieve one responder after 16 weeks of therapy (cost/responder), and a model evaluating the cost-effectiveness of introducing apremilast into the treatment pathway prior to the initiation of biologic therapies.

Comparative efficacy data were obtained from a systematic review and meta-analysis of randomized clinical trials. The primary outcome was a ≥75% reduction in the Psoriasis Area and Severity Index score (PASI-75) at the end of the trial period. US wholesale acquisition (WAC) and approved labeled dosing were used to derive drug treatment costs. Cost and efficacy comparisons were made at Week 16 for the cost per responder analysis, and after 10 years for the cost-effectiveness analysis. Apremilast had the  lowest cost per PASI-75 responder at Week 16 ($18,938) compared to adalimumab ($20,294), etanercept ($33,508), ustekinumab 45 mg ($21,497) and ustekinumab 90 mg ($39,857).

Introducing apremilast into the treatment pathway prior to biologics was estimated to provide an additional 0.74 years (5.00 vs. 4.26 years) of PASI 75 response by extending total time spent on active therapy. Furthermore, the apremilast pathway was found to be less costly, mainly due delaying or eliminating the need for biologic therapy in some patients (costs reduced by $9,072.39 over 10 years).

Bibliography

1. Tencer T, Clancy C, Damera V et al. Economic Evaluation of Apremilast in the Treatment of Moderate to Severe Psoriasis in the United States. Presented at: 73rd Annual Meeting of the American Academy of Dermatology (AAD) 2015; San Francisco, Calif., March 20-24, 2015.
2. Feldman S, Tencer T, Clancy C et al. Cost per Responder of Apremilast Versus Etanercept, Adalimumab, and Ustekinumab in Patients With Moderate to Severe Psoriasis. Presented at: 73rd Annual Meeting of the American Academy of Dermatology (AAD) 2015; San Francisco, Calif., March 20-24, 2015.