Psoriasis: are biologics cost-effective in children?

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  • Adalimumab (Humira), etanercept (Enbrel), and ustekinumab (Stelara) offer some benefits for plaque psoriasis in children and young people, but the majority of incremental cost-effectiveness ratios (ICERs) were above National Institute for Health and Care Excellence (NICE)’s usual threshold.

Why this matters

  • The present analysis suggests biologics may not be cost-effective for the treatment of psoriasis in children and young people.

Key results

  • Compared with methotrexate, adalimumab led to significantly greater responses in Psoriasis Area and Severity Index (PASI) 50 and 75 but not PASI 90 at 16 wk.
  • Etanercept significantly improved PASI 50, 75, and 90, and PGA 0/1 response rates vs placebo at 12 wk.
  • Improvements in health-related QoL were larger for etanercept than placebo but reached statistical significance only when measured using the Children’s Dermatology Life Quality Index.
  • In children aged 12-17 y, standard and half dose ustekinumab were significantly more effective than placebo in improving PASI 50, 75, and 90 and PGA 0/1 responses at 12 wk.
  • ICER for adalimumab vs methotrexate as an alternative to systemic therapy was £308,329 per quality-adjusted life year (QALY).
  • After failed systemic therapy in those aged 6-11 y, ICER for etanercept vs best supportive care (BSC) was £71,903/QALY and for adalimumab vs etanercept was £174,519/QALY.
  • After failed systemic therapy in those aged 12-17 y, ustekinumab was most effective and most costly, followed by adalimumab, etanercept, and BSC.
  • Individual pairwise ICERs for etanercept, adalimumab, and ustekinumab vs BSC were £137,059, £110,430, and £116,568 per QALY, respectively.

Study design

  • Review of literature, regulatory sources, European psoriasis registries, company submissions, and previous NICE technology appraisal.
  • Funding: National Institute for Health Research Health Technology Assessment programme.


  • Small cohort.
  • Limited follow-up.
  • Absence of young children.