(100) The Economic Impact of Ustekinumab in the Treatment of Psoriasis: A Targeted Literature Review

Background: : Ustekinumab is an interleukin-12/23 inhibitor biologic that is used to treat various indications including psoriasis (PsO). Several clinical and real-world evidence studies have demonstrated the efficacy and safety of ustekinumab among patients with PsO; however, its high cost may affect its cost-effectiveness, resulting in reimbursement restrictions that impact patient access and use.

Objective: : The objective of this literature review was to understand the economic impact of ustekinumab’s reference product in the treatment of patients with PsO.

Methods: : A literature search was conducted in MEDLINE from January 2018 to March 2024 for models evaluating the economic impact of ustekinumab. Key terms “budget impact model”, “cost-effective*”, “cost-utility”, “cost per responder” (CPR), “economic model”, and “psoriasis” were searched. Only studies published in English were eligible for inclusion.

Results: : A total of 56 articles were screened yielding 17 studies with payer perspectives from the United States (US) payer (n=7), Japan (n=2), and one publication from the German, Philippine, Chinese, French/German, Australian, Italian, Spanish, and Dutch payer perspective. Two studies found ustekinumab was the lowest-costing biologic (Dutch and Spanish payers). However, more recent CPR analyses for payers in Italy and France/Germany found that ustekinumab incurred the highest CPR compared to other biologics (i.e., golimumab and risankizumab). Cost-effectiveness analyses unanimously reported that ustekinumab was not cost-effective at current willingness to pay thresholds. No studies ran analyses with a lower cost ustekinumab biosimilar which could have positively influenced its economic profile. However, one analysis conducted in the Philippines noted the effectiveness of ustekinumab was similar to the most cost-effective treatments (i.e., ixekizumab and secukinumab), however its higher unit drug cost negatively affected the incremental cost-effectiveness ratio.

Conclusions: : Ustekinumab is typically among the most expensive therapies to treat patients with PsO leading to low probabilities of cost-effectiveness compared to other biologics. As the economic burden for PsO is rising globally, newer cost-saving therapeutic options such as biosimilars, that are offered at a more affordable price, may provide needed savings that could expand patient access. Future studies should be performed to evaluate the potential economic savings from the use of a ustekinumab biosimilar for the treatment of PsO.

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