Saturday, June 22, 2024

Evaluating Cost-Effectiveness of Deucravacitinib for Psoriasis Treatment

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The Center for Outcomes Research and Economic Evaluation for Health (C2H), National Institute of Public Health (NIPH), has released its evaluation of deucravacitinib (brand name: Sotyktu) on psoriasis. The drug, which has shown efficacy where existing treatments have failed, is now under thorough scrutiny to understand its economic and clinical benefits.

Deucravacitinib is indicated for patients with chronic plaque psoriasis, pustular psoriasis, and erythrodermic psoriasis who have not responded adequately to existing treatments. As of April 2024, the drug is priced at 2,770.90 yen. This price was determined based on a comparative method (I) with similar drugs and designated as a cost-effectiveness evaluation target (H1).

Evaluating Psoriasis Treatments

The drug is used for patients who have shown inadequate response to existing treatments. The cost-effectiveness evaluation framework was set up by the specialist organization, targeting the following analysis populations:

Patients who have not used systemic biological therapy post-systemic therapy.

Patients with no history of systemic therapy.

For patients who have not used systemic biological therapy post-systemic therapy, a direct comparison of deucravacitinib and risankizumab was not found in randomized controlled trials (RCTs). The manufacturer conducted a network meta-analysis (NMA) incorporating 96 RCTs.

The results showed an improvement in the odds ratio for achieving PASI 75 at 10-16 weeks with deucravacitinib compared to risankizumab, particularly in Asian patients. However, the odds ratio remained below 1, indicating no additional benefit of deucravacitinib over risankizumab in public analysis.

For patients with no history of systemic therapy, systematic review identified two trials, POETYK-PSO-1 and POETYK-PSO-2, comparing deucravacitinib directly to apremilast. In the POETYK-PSO-1 trial, 58.4% of patients achieved PASI 75 at 16 weeks with deucravacitinib, compared to 35.1% with apremilast. The POETYK-PSO-2 trial showed 53.0% achievement with deucravacitinib versus 39.8% with apremilast. These results demonstrated a statistically significant higher PASI 75 achievement rate for deucravacitinib, indicating additional utility over apremilast in public analysis.


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Evaluating Deucravacitinib’s Efficacy in Psoriasis Management

The manufacturer conducted a cost-effectiveness analysis using a Markov model comprising four health states: induction, maintenance, best supportive care (BSC), and death. The model assumes that patients who begin treatment with deucravacitinib or apremilast and achieve PASI 75 or higher will move to one of three maintenance states (PASI 100, PASI 90-100, PASI 75-90). Patients who do not achieve PASI 75 or discontinue treatment move to subsequent treatments, eventually transitioning to BSC for life.

Quality of life (QOL) values from the POETYK-PSO-1 and POETYK-PSO-2 trials were used, along with pooled EQ-5D-3L values from previous NICE cost-effectiveness analyses. The public analysis re-evaluated these QOL values using the Japanese conversion table. Additionally, annual hospitalization rates for BSC were estimated using anonymized receipt data and specific health check-up data (NDB).

The incremental cost-effectiveness ratio (ICER) results were as follows:

For patients who had not used systemic biological therapy post-systemic therapy, deucravacitinib showed no additional utility compared to risankizumab, with an ICER indicating less cost-effectiveness.

For patients with no history of systemic therapy, deucravacitinib showed additional utility compared to apremilast, with an ICER of 6,045,505 yen per QALY.

Deucravacitinib has demonstrated significant promise in the treatment of psoriasis, particularly for patients with no history of systemic therapy, where it showed additional utility over apremilast. However, for patients who had not used systemic biological therapy post-systemic therapy, it did not show additional utility compared to risankizumab.

These findings highlight the importance of evaluating both clinical efficacy and cost-effectiveness in treatment options. As healthcare systems increasingly focus on value-based care, understanding the nuanced benefits of different treatments becomes crucial. Comprehensive evaluations like these ensure that patients receive the most effective and economically viable therapies available. This approach not only improves patient outcomes but also optimizes resource allocation in healthcare.



Resource: Center for Outcomes Research and Economic Evaluation for Health, May 28, 2024

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