Number needed to treat and costs per responder among biologic treatments for moderate-to-severe plaque psoriasis in Japan

Background: Biologics have been shown to improve the outcomes of patients with psoriasis but their cost is an issue.Objective: Determine the number needed to treat (NNT) to achieve a 75%/90% reduction in the Psoriasis Area and Severity Index (PASI-75/90) and evaluate the incremental cost per PASI-75/90 responder (CPR) relative to placebo in Japan.Methods: A network meta-analysis was conducted to estimate the relative probabilities of achieving PASI-75/90 and NNTs. Drug costs were assessed based on Pharmaceutical and Medical Device Agency-approved dosing. The CPR was estimated for a short-term induction period and first year of treatment.Results: Compared with placebo, the PASI-75 NNT was 1.27 for adalimumab 80mg, 1.29 for secukinumab 150mg, 1.36 for secukinumab 300mg, 1.57 for adalimumab 40mg, 1.68 for ustekinumab 90mg, 1.97 for ustekinumab 45mg and 2.00 for infliximab 5mg/kg. The short-term PASI-75 CPR relative to placebo was $5,062 for secukinumab 150mg, $8209 for adalimumab 40mg, $10,654 for secukinumab 300mg, $11,754 for adalimumab 80mg, $15,407 for ustekinumab 45mg, $19,147 for infliximab 5mg/kg and $26,257 for ustekinumab 90mg. A similar ranking was observed for one-year PASI-75 CPRs and PASI-90 NNTs and CPRs.Conclusion: Adalimumab 40mg/80mg and secukinumab 150mg/300mg were the most efficacious and cost-efficient for patients with psoriasis in Japan.