Cost Per Additional Responder Associated With Ixekizumab and Etanercept in the Treatment of Moderate-to-Severe Psoriasis

December 2017 | Volume 16 | Issue 12 | Original Article | 1246 | Copyright © December 2017

Steven R. Feldman MD PhD,a Shonda A. Foster PharmD MS,b Baojin Zhu PhD,b Russel Burge PhD,b,c Sarah Al Sawah PhD,b and Orin M. Goldblum MDb

aWake Forest School of Medicine Dermatology, Winston-Salem, NC bEli Lilly and Company, Lilly Corporate Center, Indianapolis, IN cWinkle College of Pharmacy, University of Cincinnati, Cincinnati, OH


BACKGROUND: Newer psoriasis treatments can achieve greater levels of effcacy than older systemic therapies; however, current pso-riasis costs are substantial. We sought to estimate costs per additional responder associated with ixekizumab and etanercept, versus placebo, using effcacy data from phase 3 clinical trials (UNCOVER-2 and UNCOVER-3).

METHODS: In UNCOVER-2/UNCOVER-3, patients received subcutaneous placebo, etanercept 50 mg twice weekly (BIW), or ixekizumab one 80 mg injection every 2 weeks (Q2W) after a 160-mg starting dose. Twelve-week induction-phase Psoriasis Area and Severity Index (PASI) 75, PASI 90, and PASI 100 response rates for ixekizumab, etanercept, and placebo were obtained from pooled data from the overall and United States (US) subgroup intention-to-treat (ITT) populations, and used to calculate numbers needed to treat (NNTs) to achieve one additional PASI 75, PASI 90, or PASI 100 response for ixekizumab Q2W and etanercept BIW versus placebo. Twelve-week drug costs per patient were calculated based on the UNCOVER-2/UNCOVER-3 dosing schedule and wholesale acquisition costs. Mean costs per additional responder for PASI 75, PASI 90, and PASI 100 for each treatment versus placebo were calculated for pooled UN-COVER-2/UNCOVER-3 overall and US subgroup ITT populations.

RESULTS: Pooled overall ITT population: costs per additional PASI 75, PASI 90, or PASI 100 responder were US $37,540, US $46,299, or US $80,710 for ixekizumab Q2W and US $57,533, US $120,720, or US $404,695 for etanercept BIW, respectively. US subgroup ITT population: costs per additional PASI 75, PASI 90, or PASI 100 responder were US $38,165, US $49,740, or US $93,536 for ixekizumab Q2W and US $69,580, US $140,881, or US $631,875 for etanercept BIW, respectively.

CONCLUSIONS: Twelve-week costs per additional responder were lower for ixekizumab Q2W than for etanercept BIW across all levels of clearance (PASI 75, PASI 90, and PASI 100) in the pooled UNCOVER-2/UNCOVER-3 overall and US subgroup ITT populations.

J Drugs Dermatol. 2017;16(12):1246-1252.


Psoriasis is a common immune disease characterized by thick scaly red lesions and systemic comorbidities. Psoriasis has an enormous effect on patients’ lives, reducing health-related quality of life to an extent similar to that seen with other major medical conditions.1 The total cost of psoriasis to society encompasses third-party medical and prescription drug costs, patient expenditures for over-the counter medicines, lost work time, reduced productivity, and diminished quality of life. Estimates of direct psoriasis costs alone in the United States (US) in US dollars, year 2013 values, ranged from $51.7 to $63.2 billion per annum, with the annual US cost of psoriasis to society approximating $112 billion.2 A large number of treatments are available for moderate-to-severe psoriasis, ranging from phototherapy to systemic agents, including adalimumab, etanercept, infliximab, secukinumab, ustekinumab, and ixekizumab. Ixekizumab is a high-affinity monoclonal antibody that selectively targets interleukin-17A.3 The efficacy and safety of ixekizumab were established in three randomized clinical trials, including two prospective, double-blind, multicenter, international, phase 3 studies (UNCOVER-2 [NCT01597245] and UNCOVER-3 [NCT01646177]) that compared ixekizumab and etanercept with placebo. In both UNCOVER-2 and UNCOVER-3, ixekizumab was more effective than etanercept.4 The Psoriasis Area and Severity Index (PASI) is the most commonly utilized outcome measure for efficacy evaluation in clinical trials; success is often measured by the proportion of people who achieve at least a 75% reduction in PASI score from baseline (PASI 75). However, patients prefer even greater levels of clearing,5–6 and newer psoriasis treatments achieve these greater levels of improvement (90% and 100% reductions in PASI scores) more frequently.7 To allow healthcare decision makers to compare the relative cost per additional responder needed to achieve higher levels of clearance (PASI 90 and PASI 100 response rates) across