Abstract: Objective: To evaluate the cost-effectiveness of interleukin (IL)-17A antagonists, TNF-α antagonists, and IL-23 antagonists in the treatment of moderate-to-severe plaque psoriasis. Methods: A Markov model was constructed according the phase III clinical trial data to compare the medical costs and effectiveness of biological agents during treatment for psoriasis. The costs and utility parameters from published literature and various publicly available statistical information. Cumulative medical costs, Quality Adjusted Life Year (QALY), and Incremental Cost Effectiveness Ratio (ICER) were used as the outcome. One-way sensitivity analysis(DSA) and probability sensitivity analysis(PSA) was conducted to verify the robustness of the model results. Results: Over the course of a year, compared with secukinumab, the ixekizumab would produce an additional 0.04 QALYs, and the total costs were saved ￥21099.91. Compared with adalimumab, ixekizumab had an absolute cost-effectiveness advantage by adding 0.46 QALYs while reducing the medical cost of ￥18977.40. The incremental QALYs of guselkumab were 0.09 compared with ixekizumab and 0.59 compared with adalimumab, while with an incremental cost-effectiveness ratio (ICER) much greater than three times GDP per capita, guselkumab did not demonstrate a cost-effectiveness advantage over. ixekizumab and adalimumab. According to the analysis results of the model, the cost-effectiveness advantage relationship between various biologics was expressed as follows: IL-17A antagonists > TNF-α antagonists > IL-23 antagonists based on current health service costs in our country. Probabilistic sensitivity analyses confirmed the robustness of the results. Conclusion: IL-17A antagonists provide more cost-effective advantages than TNF-α antagonists and IL-23 antagonists in the treatment of moderate to severe plaque psoriasis.

Key words: biologic, ixekizumab, secukinumab, adalimumab, guselkumab, psoriasis, cost-effectiveness