国立保健医療科学院 保健医療経済評価研究センター

Center for Outcomes Research and Economic
Evaluation for Health (C2H), National Institute of
Public Health (NIPH)| URL: https://c2h.niph.go.jp

October 30th, 2023
[C2H2203] Summary of cost-effectiveness evaluationof bimekizumab (BIMZELX®)

1. Indication
The treatment of plaque psoriasis, generalized pustular psoriasis, and psoriatic
erythroderma in patients who are not sufficiently responding to existing treatments
2. Price of the drug
Bimekizumab has been reimbursed since April 2022. Drug prices were Japanese Yen(JPY) 156,587 for syringe for subcutaneous (SC) injection and JPY 156,820 for
autoinjector for SC injection (as of October 2023). The price is calculated based ona similar efficacy comparison method (I), with a 10% usefulness premium (II) anda price maintenance premium. This product is designated as an H1
cost-effectiveness evaluation item.
3. Scope of cost-effectiveness evaluation
This product is indicated for the treatment of plaque psoriasis, generalized pustularpsoriasis, and psoriatic erythroderma in patients who are not sufficiently responding
to existing treatments. The scope of evaluation agreed upon at the first session of
the Expert Committee of Cost-Effectiveness Evaluation (ECCEE) is described below.
The target population was patients with plaque psoriasis who were not sufficiently
responding to existing treatments. The comparator selected for the target population
was ixekizumab because it is less expensive.

Population

Patients with plaque psoriasis
responding to existing treatments

whoarenot

sufficiently

Comparator

Select the less expensive of risankizumab and ixekizumab

4. Evaluation of additional benefits
The results of network meta-analysis (NMA) conducted by the academic group wereas follows: The Psoriasis Area and Severity Index (PASI) response rate ofbimekizumab were higher for PASI 75: 0.920, PASI 90: 0.837, and PASI 100: 0.574
compared with ixekizumab, PASI 75: 0.896, PASI 90: 0.739, and PASI 100: 0.392.
The odds ratio (95%CI) of PASI 50, PASI 75, PASI 90, and PASI 100 (vs. ixekizumab)
was 1.18 (0.41-3.27), 1.40 (0.91-2.14), 1.79 (1.18-2.72), and 1.15 (0.63-2.14) forbimekizumab, respectively. The academic group was concerned about uncertaintyregarding the NMA methodology; however, they concluded that bimekizumab hasadditional benefits compared with the comparator.

5. Results of the cost-effectiveness analysis
The manufacturer performed a lifetime cost-effectiveness analysis comparing
bimekizumab with ixekizumab for a Markov model. The academic group considered
the following 3 points:• The mean medical costs per 2-week maintenance period were estimated, because
the estimation method for the ratio of maintaining initial treatment interval had
some challenges related to validity.
• The secondary treatment setting was an obvious cause of increased uncertainty inthe model. Therefore, the academic group decided to conduct the base caseanalysis considering parameters up to primary treatment, and the scenario
analysis was also conducted varying the secondary treatment initiation rate andtime horizons.
• The PASI response rates were based on the results of the NMA recalculated during
the evaluation of additional benefits.
The table below shows the results of the cost-effectiveness analysis conducted by theacademic group. Slight changes in the key parameters had varied the results of theanalysis from dominant to positive incremental cost-effectiveness ratio (ICER). The
academic group considered the estimating cost of bimekizumab and the comparator
to be approximately comparable. Therefore, there is some question as to whether it
is appropriate to calculate point estimation for ICER. Finally, the academic groupconcluded that it is most probable that ICER was included in the less-than-2-million
Japanese Yen/quality-adjusted–life-year (QALY) range.

SecondaryTime
treatment
horizons
initiation rate(years)
Base case analysis

Incremental
effect (QALY)

Incrementalcost (JPY)ICER(JPY/QALY)

0%Lifetime
Scenario analysis
Lifetime

0.1832360,189

1,965,600

0.0195-18,807

Dominant

10y
5y
3yLifetime

0.01710.01260.00890.0211-13,427-3,274
4,998
14,745

Dominant
Dominant
562,248
698,52410y
5y
3y

0.01850.01360.0095

16,132
18,75020,884872,394
1,383,284
2,190,871

100%

90%

80%

Lifetime

0.0227

48,297

2,127,212

10y0.019945,692

2,299,254

5y
3y0.01450.0102

40,77536,7692,806,555
3,613,937

JPY: Japanese Yen, QALY: quality-adjusted life year, ICER: incremental
cost-effectiveness ratio
The ECCEE accepted the following:

Population

Comparator

ICER(JPY/QALY)Patients with plaque psoriasis who are notsufficiently responding to existing treatments

Ixekizumab

1,965,600