• Model structure (Markov)
• Tx allocation based on PASI 75 response
• Tx-related AEs not included
• 14-w cycle length

• Model structure (Markov)
• Tx allocation based on PASI 75 response
• Tx-related AEs not included

• RIS and INF not included as comparators
• 5-y TH (CADTH submission 10-y TH base case; 5-y as scenario analysis)
• Second-line treatment not included in SMC submission
• Tx discontinuation from UK BADBIR observational study and assumed consistent across all tx
• Utility estimates derived using EQ-5D-3L data from reSURFACE 1 clinical study and pooled across study arms according to PASI status
• SMC submission seems to have included a sponsor-conducted Bayesian NMAs, CADTH submission existing NMA was used⁴
• CMA vs adalimumab and ustekinumab. CUA vs others

• Lifetime TH
• RIS and INF not included as comparators
• Second-line treatment not used
• Base case includes tx sequences
• Tx discontinuation from UK BADBIR observational study and assumed consistent for all tx
• Utility estimates using EQ-5D-3L data from reSURFACE 1 clinical study
• Common 14-w induction length for each tx
• NICE submission seems to have included a sponsor-conducted Bayesian NMAs, in CADTH submission existing NMA used⁴
• Discount rate of 3.5%

• ICERs were provided for each cost-utility analysis as a pairwise comparison. Secukinumab and guselkumab were dominated by TIL, whereas brodalumab and ixekizumab were less effective but less costly
• CMA results not reported — commercial in confidence

• There were 2 non-dominated sequences. The least effective and lowest cost was TIL-ustekinumab-secukinumab sequence. The ICER was £152,838 (CA$94,653)^a per QALY vs non-TIL sequence.

• Costs of BSC are based on outdated data
• Uncertainty in relative effectiveness of TIL
• Assumptions that patients only receive one line of tx before BSC, and PASI 90 to 99 and 100 could be combined are simplifying
• Utilities for BSC state assumed to be equivalent to patients’ baseline utility in reSURFACE 1, despite majority being biologic-naive and therefore potentially unrepresentative

• Tx sequences included restricted number of tx and position of TIL.
• Company’s base case evaluated TIL with 14-w induction in base case. The indication for TIL states that a 28-w induction is appropriate.
• Company calculated cost of induction for TIL and all comparators using a common 14-w stopping rule.
• BSC costs from Fonia (2010) more appropriate.
• European value set for EQ-5D-3L rather than the UK value set.
• Company base case does not include health care costs for patients who fail to respond to biologics and switch to another tx or BSC.
• INF not included.

• λ = £20,000 per QALY: adalimumab, etanercept, TIL 100 mg (14 w), TIL 100 mg (28 w) cost effect vs BSC.
• λ = £30,000 per QALY: adalimumab, etanercept, ustekinumab, TIL 100 mg (14 w), TIL 100 mg (28 w) cost effect vs BSC.

TIL recommended for treating plaque psoriasis in adults, only if disease is severe and not responded to other systemic tx, or these options are contraindicated or not tolerated

Consider stopping TIL from 12 to 28 w if not at least a 50% reduction in PASI score from when treatment started. Stop TIL at 28w inadequate response.