A comparison of anti-IL-17A, anti-TNF, and anti-IL-12/23 biologics for moderate-to-severe plaque psoriasis in India, based on cost per NNT and its effect on the therapeutic landscape and outcome

Background Though biologics have changed the therapeutic landscape in moderate-to-severe plaque psoriasis (PsO), their high cost is a major cause for restricted usage. Objective To compare the relative efficacy (Psoriasis Area Severity Index (PASI) 90/100) and cost of biological agents available in India for moderate-to-severe PsO based on the cost per number needed to treat (NNT). Methods NNTs of biologicals derived from published network meta-analyses (NMA) for psoriasis area and severity index (PASI) 90&100, were used to calculate the cost per NNT by multiplying the NNT of a drug by the number of doses required and the corresponding market price in India. The calculated cost was based on the maximum retail price (MRP) at 12, 24, 52, and 104 weeks of treatment. Results The most economical drug based on MRP was ustekinumab (biosimilar). The cost per NNT (PASI100) was lowest for ixekizumab at all time points, followed by ustekinumab. For PASI90, the cost per NNT was lowest for ustekinumab at all time points, followed by ixekizumab. Limitations NNT values from previously published NMA data were used. Cost-per-NNT analyses were based on Randomised control trial (RCT) evidence and, thus, could not account for real-world factors that may impact the true cost of therapy. The cost of biologics varies due to the changes in the prices of the brands and the availability of biosimilars. Also, our analysis did not account for any adverse effects and their costs. Conclusion Ixekizumab and ustekinumab were the most cost-effective biologics to achieve PASI100 and PASI90, as cost per NNT analysis. This data can be used by procurement agencies and dermatologists to estimate the cost to patients on short and long-term bases.