Biologic treatment sequences for plaque psoriasis: a cost–utility analysis based on 10 years of Dutch real‐world evidence from BioCAPTURE

Summary Psoriasis is a chronic inflammatory skin condition. It can be unsightly and uncomfortable, significantly affecting quality of life. It is usually treated with regular applications of creams, but more severe psoriasis requires immune‐suppressive medication given by mouth or injection. Newer, targeted “biologic” drugs are more effective but expensive, and cost‐benefit data is limited. Patients in the real world often differ from those selected for randomised control trials (RCTs) in having additional illnesses, and are often switched from one drug to another to improve efficacy or reduce side‐effects; there is no evidence to inform clinicians about what order to use them in. This industry‐sponsored study from Holland analysed the cost‐effectiveness of three biologic drugs, adalimumab, etanercept and ustekinumab, given in different sequences over 10 years. A computerised simulation used published information on drug and monitoring costs and “real world evidence” from 318 patients already enrolled in a Dutch registry called BioCAPTURE (Continuous Assessment of Psoriasis Treatment Use Registry with Biologics) which includes quality of life scores as well as clinical outcomes (i.e. symptoms) and details of treatment. Mean age at enrolment was 47 years, mean body weight 87 kg and mean biologic treatment course duration 29.6 months. They estimated that treatment of psoriasis with these biologics for ten years costs €141,962 to €148,442 per patient. Starting with adalimumab or ustekinumab rather than etanercept costs somewhat less for each additional year in perfect health, even when modelled using cheaper “biosimilars”, and is thus considered advantageous in health‐economic terms, at least within an academic centre. Linked Article: Klijn et al. Br J Dermatol 2018; 178:1181–1189