Costo per responder del metotrexato rispetto ad altre terapie in pazienti con psoriasi a placche da moderata a grave in Italia

OBJECTIVE: Conventional synthetic disease modifying antirheumatic drugs (csDMARDs) were recommended in 2019 as first line therapy from Italian Medicines Agency (AIFA) for the treatment of moderate to severe psoriasis. Updated local guidelines recommended methotrexate (MTX) as the drug of first choice. Nevertheless, MTX is reported by AIFA to be underused. Since no study evaluated jointly the first-line efficacy and costs of the most widely used biologic drugs (adalimumab, etanercept, secukinumab and ustekinumab) and methotrexate in Italy, a cost per responder (CPR) analysis was performed. METHODS: A CPR model was developed based on efficacy data from a published Cochrane network meta-analysis. Drug costs included in the model were estimated based on average regional tender prices. The primary analysis assessed the CPR of both Psoriasis Area and Severity Index (PASI) 90 at weeks 12 and 52. A secondary analysis was conducted considering PASI 75. For methotrexate, both an average dosage of 13.4 mg, estimated by an expert panel, and a dosage of 15 mg reported in European guidelines were considered. RESULTS: At weeks 12 and 52, the costs per responder PASI 90 were lower for methotrexate 13.4 mg compared to the most widely used biologics in Italy, € 566.71 and € 2,455.72 respectively. Methotrexate also showed a lowest CPR both at 12 and 52 weeks, € 529.95 and € 2,296.47 respectively, in the secondary analysis. CONCLUSIONS: The analysis showed a lower cost per responder for methotrexate than for adalimumab, etanercept, secukinumab and ustekinumab. For healthcare budget holders, this means using the saved resources to treat more patients.