According to a network meta-analysis and cost-per-responder (CPR) analysis presented at the recent Academy of Managed Care Pharmacy annual meeting, adalimumab was the most cost-effective biologic for the treatment of psoriatic arthritis (PsA) in terms of incremental CPR for 2 clinical efficacy measurements and at 2 time points, weeks 12 and 24.
Keith Betts, PhD, of the Analysis Group Inc, Boston, Massachusetts, determined the CPR for drugs used in treating PsA: the tumor necrosis factor-α (TNF-α) inhibitors adalimumab, certolizumab, etanercept, golimumab, and infliximab; the interleukin 12/23 inhibitor ustekinumab; and the oral phosphodiesterase (PDE4) inhibitor apremilast.
“Reliable evidence about the comparative effectiveness of these therapies is needed to inform clinical and economic decisions regarding their use,” the authors suggested on their poster.
They identified 16 publications that included the clinical efficacy measures of ACR20 and PASI75, and determined the relative probability of achieving these measures with each drug (at approved doses) at weeks 12 and 24. They also calculated the number needed to treat (NNT) and compared cost per incremental ACR20 and PASI75 responder.
In terms of relative effectiveness on the PASI75 at week 12, the NNTs were significantly lower for adalimumab and infliximab, compared to apremilast, which held true for week 24, with golimumab also significantly lower. For ACR20, adalimumab, etanercept, infliximab, and golimumab had significantly lower NNTs relative to apremilast and ustekinumab 90 mg at week 12. At week 24, adalimumab and golimumab had significantly lower NNTs relative to apremilast and ustekinumab 45 mg.
The incremental costs per ACR20 responder at week 24 were found to be quite low for 4 drugs: adalimumab ($36,496), golimumab ($39,928), etanercept ($48,439), and infliximab ($48,577). Higher costs were observed with apremilast ($59,526), certolizumab ($65,777), ustekinumab 45 mg ($117,164), and ustekinumab 90 mg ($188,879).
Importantly, the authors noted that adalimumab, infliximab, and golimumab were consistently associated with lower CPR for treating both joint and skin symptoms related to PsA. “In the treatment of PsA, the goal of therapy is to have improvements in both skin and joint symptoms,” they stated.
Etanercept was only associated with lower CPR for treating joint symptoms related to PsA, and certolizumab, ustekinumab, and apremilast were not associated with lower CPR for treating either skin or joint problems related to PsA, their study found.
Disclosure: The study was funded by AbbVie, Inc.
Betts K, Griffith J, Reichmann W, et al. Network meta-analysis and cost per responder of tumor necrosis factor, interleukin, and phosphodiesterase inhibitors in the treatment of psoriatic arthritis. Poster presented at: Academy of Managed Care Pharmacy 27th Annual Meeting & Expo; April 7-10, 2015; San Diego, CA.