title: Cost utility analysis based on a head-to-head Phase 3 trial comparing ustekinumab and etanercept in patients with moderate-to-severe plaque psoriasis: a Canadian perspective.
abstract: OBJECTIVE
  A head-to-head comparator study has shown that the clinical efficacy of ustekinumab is superior to that of etanercept over a 12-week period in patients with psoriasis. Economic models are often hindered by the lack of trials directly comparing outcomes between relevant alternative therapies. The aim of this analysis was to evaluate the cost-effectiveness of ustekinumab versus etanercept among adults with moderate-to-severe plaque psoriasis based on a Phase 3 head-to-head trial.
  
  
  METHODS
  The Markov model incorporates trial data from the Active Comparator (CNTO 1275/Enbrel) Psoriasis Trial study (ustekinumab 45 mg at Weeks 0 and 4; etanercept 50 mg biweekly) to follow patient response to initial treatment using the modeling approach developed by the Centre for Reviews and Dissemination, University of York, and often cited by others conducting economic analyses of psoriasis. Beyond the initial trial period, the Canadian model extrapolates results up to 10 years.
  
  
  RESULTS
  Over the 10-year time horizon of the model, the mean annual costs were $16,807 for ustekinumab (45 mg) and $19,525 for etanercept (50 mg). The incremental difference in costs and utilities remained in favour of ustekinumab across a range of sensitivity analyses.
  
  
  CONCLUSIONS
  This model highlights the advantage of having head-to-head comparative trial data relevant to the at-risk population. Our model shows that ustekinumab is more cost-effective than etanercept for patients with moderate-to-severe plaque psoriasis.
authors.affiliation: United BioSource Corporation, Bethesda, MD 20814, USA. feng.pan@unitedbiosource.com
authors.forename: Feng
authors.initials: F
authors.lastname: Pan
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Brazier
authors.forename: Neil H
authors.initials: NH
authors.lastname: Shear
authors.forename: Farah
authors.initials: F
authors.lastname: Jivraj
authors.forename: Brad
authors.initials: B
authors.lastname: Schenkel
authors.forename: Ruth
authors.initials: R
authors.lastname: Brown
mesh_terms: D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D002170:Canada; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004311:Double-Blind Method; D016527:Drug Costs; D000068800:Etanercept; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007074:Immunoglobulin G / Q000191:economics* / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use; D007349:Insurance, Health, Reimbursement; D008390:Markov Chains; D018803:Models, Economic; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012044:Regression Analysis; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D000069549:Ustekinumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D000069549:Ustekinumab; D000068800:Etanercept