Cost-Utility Analysis and Comparative Effectiveness Analysis of Biologic Treatment of Moderate-to-Severe Psoriasis in Saudi Arabia

Abstract Background: Psoriasis is a chronic, immune-mediated disease of the skin and joints, with a global prevalence of 2%–3%. Psoriasis area and severity index (PASI) 75 is accepted as a scoring system to evaluate baseline reasonable response to therapy. However, with advent of newer biologics, the PASI90 outcome is now potentially achievable. Objective: To assess the cost-utility of achieving PASI75 or PASI90 using risankizumab in psoriasis patients in Saudi. Materials and Methods: A Markov model was developed with a 12-week cycle length and 40-year time horizon from a healthcare payer perspective. Costs considered were related to drug acquisition, drug administration, medical resource use, adverse event management, and physician visit costs. The model compared the current treatment sequence anti-tumor necrosis factor alpha (adalimumab), interleukin (IL)12/23 inhibitors (ustekinumab), and IL-17A inhibitor (secukinumab), as the first-, second-, and third-line treatments, respectively, targeting PASI75 versus IL-23 inhibitor (risankizumab) as the first-line treatment option, targeting PASI90. Results: Using the current treatment sequence and targeting PASI75 as a clinical outcome, the overall cost of moderate-to-severe psoriasis management in Kingdom of Saudi Arabia was estimated to be 8.9 billion United States Dollar (USD), yielding 921,039 quality-adjusted life-year (QALYs). The average cost and QALY per patient was USD 0.4 million and 23.64, respectively. The use of risankizumab as the 1 st line option targeting PASI90 yielded an overall cost of 8.4 billion USD and 951,512 QALYs. The cost savings and the high QALY gain were attributed to the lower healthcare resource utilization and increased probability of achieving PASI90, respectively. Conclusion: Targeting PASI90 using risankizumab as a 1 st line treatment for moderate-to-severe psoriasis patients was found to be cost-effective.