Cost-effectiveness of biologics for moderate-to-severe psoriasis from the perspective of the Swiss healthcare system.

Treatment with biologics for moderate-to-severe psoriasis has been approved in Switzerland (2004). However, compulsory basic health insurance limits treatment in non-responders after 12 weeks; responders can continue. The study objective was to evaluate incremental cost-effectiveness ratios (ICERs) due to this regulation. Response was defined as achieving PASI 50, 75, or 90. Placebo-adjusted responder rates were gathered from randomized, controlled trials (weeks 12, 24). Total treatment costs were assessed according to Swiss prices and tariffs. Regimens investigated were infliximab (5 mg/kg IV), etanercept (50 mg SC twice weekly [tw] for 12 weeks, then 25 mg SC tw), adalimumab (80 mg SC week 0, then 40 mg every other week), efalizumab (1 mg/kg/week SC), and alefacept (15 mg/week IM, 12 weeks). Cost effectiveness was calculated as ICER per PASI 50, 75, and 90 responder. Treatment with infliximab led to the highest response rates. Infliximab demonstrated lowest ICER per PASI 90 responder of CHF 22,995 at 12 weeks. Modeling treatment changes at 12 weeks over 36-weeks-horizon resulted in lowest ICER per PASI 75 responder for adalimumab and infliximab compared to the other biologics. Hence in Switzerland, selecting the initial biologic with a high response rate evidenced best value for money.