Appl Health Econ Health Policy. 2026 Nov 12. doi: 10.1007/s40258-026-01087-7. Online ahead of print.
ABSTRACT
OBJECTIVES: To systematically review model-based economic evaluations of interleukin pathway inhibitors for moderate-to-severe plaque psoriasis, with a focus on model structures, key assumptions, parameter sources, economic conclusions, methodological rigor, and reporting completeness.
METHODS: PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library were systematically searched from database inception through July 10, 2026, for full model-based economic evaluations in adults with moderate-to-severe plaque psoriasis in which at least one evaluated strategy included an interleukin (IL)-12/23, IL-17, or IL-23 inhibitor. Model architecture, health states, treatment sequences, sources of key parameters, and approaches to uncertainty were extracted a priori, and methodological features were compared through narrative synthesis. Methodological quality and reporting completeness were appraised using the Philips checklist and the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022), respectively. Economic findings were synthesized separately for QALY-based cost-utility analyses and Psoriasis Area and Severity Index (PASI) response-based cost-effectiveness analyses.
RESULTS: Twenty-six economic evaluations met the inclusion criteria. Thirteen used Markov or state-transition models, five used decision tree-Markov hybrids, two used decision trees, four used cost-effectiveness models without a stated formal architecture, and two used patient-level or other simulation models; 14 explicitly modeled multi-line treatment sequences. Twenty-four evaluations used evidence from randomized controlled trials as effectiveness inputs, and 19 incorporated network meta-analysis or mixed-treatment comparison estimates. Twenty-one conducted formal deterministic sensitivity analyses, with one additional evaluation reporting a limited one-way analysis; 20 conducted probabilistic sensitivity analyses, and 16 reported cost-effectiveness acceptability curves. Only four studies explicitly described tests of model logic, and none systematically compared alternative model structures; subsequent-line effectiveness and patient heterogeneity were also inconsistently addressed. Economically, 16 evaluations were QALY-based cost-utility analyses and 10 were PASI response-based cost-effectiveness analyses. No drug or treatment sequence was consistently optimal across countries; conclusions varied primarily with comparator choice, drug prices, willingness-to-pay thresholds, short-term response rates, and sequencing assumptions.
CONCLUSIONS: Existing models increasingly represent long-term, multi-line treatment pathways, but their treatment of prior treatment history, subsequent-line effectiveness and discontinuation, structural uncertainty, and model validation remains inadequate. Future evaluations should incorporate previous biologic exposure, long-term drug survival, and locally relevant utility and resource-use data, and should explicitly test important alternative model structures. Current economic conclusions are strongly model- and context-dependent; cross-country rankings should not be inferred without accounting for specific prices, thresholds, and treatment sequences. PROSPERO Registration: CRD420261413139.
PMID:43018877 | DOI:10.1007/s40258-026-01087-7