- 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.
- 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.
- 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.