What is the cheapest biological agent for treating psoriasis?

Cheapest Biological Agent for Psoriasis

Etanercept is the cheapest biological agent for treating psoriasis, particularly when administered at a dose of 25 mg once weekly. 1

Cost-Effectiveness Comparison of Biologics

First-Line Biologic Options

• Etanercept 25 mg once weekly is the most cost-effective biologic agent when measured by cost per patient achieving a minimally important difference in Dermatology Life Quality Index (DLQI) 2
• Infliximab at 3 mg/kg is the most cost-effective agent when measured by cost per patient achieving PASI-75 improvement 2
• For patients with moderate-to-severe psoriasis, guidelines recommend several first-line biologic options:
  • Ustekinumab for adults who fulfill criteria for biologic therapy 3
  • Adalimumab for adults, particularly when psoriatic arthropathy is a consideration 3
  • Secukinumab for adults with psoriasis, with or without psoriatic arthritis 3

Cost-Effectiveness Ranking

When considering both cost and efficacy together:

1. Etanercept 25 mg once weekly (lowest cost per DLQI improvement) 2
2. Infliximab 3 mg/kg IV (most cost-effective for PASI-75) 2
3. Adalimumab 40 mg every other week 2
4. Etanercept 25 mg twice weekly 2

Dosing Considerations Affecting Cost

Etanercept Dosing Options

• Standard dosing: 50 mg once weekly or 25 mg twice weekly 3, 1
• Lower cost option: 25 mg once weekly (shown to be effective in some patients) 1, 2
• Dose escalation may be needed in some patients (50 mg twice weekly), which increases cost 3

Other Biologics Dosing Affecting Cost

• Ustekinumab: 45 mg (for patients <100 kg) or 90 mg (for patients >100 kg) every 12 weeks 3
• Adalimumab: 40 mg every other week, may require escalation to weekly dosing 3
• Infliximab: 5 mg/kg at weeks 0,2, and 6, then every 8 weeks; may require more frequent dosing 3

Special Considerations

Efficacy Considerations

• Despite being the most cost-effective option, etanercept may have lower efficacy compared to newer biologics 4
• In a head-to-head comparison, ustekinumab showed superior efficacy to etanercept (73.8% vs. 56.8% achieving PASI-75) 4
• Infliximab should be reserved for very severe disease or when other biologics have failed 3

Patient-Specific Factors Affecting Choice

• Presence of psoriatic arthritis may favor adalimumab as first-line therapy 3
• For pediatric patients, etanercept (≥6 years), adalimumab (≥4 years), or ustekinumab (≥12 years) are options 3
• Patient weight affects dosing and therefore cost (particularly for ustekinumab) 3

Common Pitfalls to Avoid

• Focusing solely on acquisition cost without considering efficacy may lead to treatment failure and increased overall costs 2
• Not accounting for potential dose escalation needs when calculating long-term costs 3
• Overlooking the cost of administration (self-administered subcutaneous injections vs. infusions requiring healthcare visits) 2
• Not considering the impact of previous biologic therapy exposure on response rates and cost-effectiveness 5

When all factors are considered, etanercept at the lowest effective dose (25 mg once weekly) represents the most cost-effective first-line biologic option for psoriasis, though individual patient factors may warrant consideration of alternatives.