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Alefacept

Not recommended DermatologyAuthority RequiredLater-line line

Treatment of severe chronic plaque psoriasis in adult patients with PASI score ≥15 who are refractory, intolerant or contraindicated to currently available therapies.

2
Submissions
2 resub
2005–05
On the record
$45k–75k
ICER range
2 sourced ICERs · 2005
ICER stated
Cost basis

Decision on record

1 decision
  • Meeting Jul 2004 Not recommended Used for the treatment of chronic plaque psoriasis no PSD

Access path

2 submissions · public record
  1. Nov 2005
    Not recommended

    unacceptable and uncertain cost-effectiveness, base-case ICER numerically higher than best-case scenario from previous…

  2. Nov 2005
    Not recommended

    unacceptable and uncertain cost-effectiveness, base-case incremental cost per extra QALY gained numerically higher than…

RecommendedDeferredNot recommended

Cost-effectiveness

2 sourced ICERs · 2005
The PBAC recalled that it had judged the base-case incremental cost per extra QALY gained in the previous submission, to be unacceptably high. PBAC · 2005

Decision context

PopulationAdult patients with severe chronic plaque psoriasis (PASI score ≥15) who are refractory, intolerant or contraindicated to at least two of the following: phototherapy, cyclosporin, or methotrexate.

Why it was knocked back

  • unacceptable and uncertain cost-effectiveness, base-case incremental cost per extra QALY gained numerically higher than best-case scenario in previous submission, model made series of favourable assumptions about alefacept, omitted re-initiation of treatment option

Submission history

2 entries
DecidedOutcomeComparatorICEREvidence
Nov 2005 Not recommended placebo $45k–75k RCT · PASI-50
Nov 2005 Not recommended placebo $45k–75k RCT · PASI-50

Similar precedents

By decision profile
Efalizumab75%Biologics (Etanercept, Infliximab, Adalimumab, Ustekinumab, Secukinumab, Ixekizumab, Guselkumab, Tildrakizumab)72%Etanercept68%Imiquimod68%Leflunomide65%Imiquimod, Cream65%Guselkumab64%Apremilast64%

Regulatory · TGA

Label narrower than PBS population — PBAC restricts to severe psoriasis (PASI ≥15) with prior treatment failure/intolerance/contraindication; TGA label includes moderate-to-severe without these requirements.