{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:49:14Z","timestamp":1792788554316,"version":"4.5.0"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T00:00:00Z","timestamp":1723161600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Novartis (Thailand) Limited","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Background<\/jats:title>\n Biologics has been known to be effective for patients with psoriasis. However, optimal treatment pathways and their cost-effectiveness are limited in a resource-limited country. This study assessed the cost-effectiveness of different sequential biologics for moderate-to-severe plaque psoriasis.<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n \n A hybrid model from a societal perspective was used. Model inputs were derived from network meta-analysis, clinical trials, and published literature. Three different sequential biologic treatments were assessed; Sequence 1; 1\n st<\/jats:sup>\n Interleukin-17 (IL-17) inhibitor (secukinumab) followed by 2\n nd<\/jats:sup>\n IL-17 inhibitors (ixekizumab or brodalumab), then 3\n rd<\/jats:sup>\n IL-23 inhibitor (guselkumab), Sequence 2; ixekizumab followed by secukinumab or brodalumab, then guselkumab, and Sequence 3; brodalumab followed by ixekizumab or secukinumab, then guselkumab. Methotrexate or ciclosporin was used as standard of care (SoC).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n All three different sequential biologic therapies could gain total quality-adjusted life year (QALY), but they had higher cost than SoC. Sequence 1 had the lowest incremental cost-effectiveness ratio (ICER) compared to SoC at 621,373 THB\/QALY (19,449 $\/QALY). ICER for Sequence 2 was 957,258 THB\/QALY (29,962 $\/QALY), while that for Sequence 3 was 1,332,262 THB\/QALY (41,700 $\/QALY). Fully incremental analysis indicated that Sequence 3 was dominated by Sequence 1 and Sequence 2. ICER for Sequence 2 was 7,206,104 THB\/QALY (225,551 $\/QALY) when compared to Sequence 1.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n At the current willingness-to-pay of 160,000 THB\/QALY, no sequential IL-17 inhibitor was cost-effective compared to SoC. Secukinumab followed by ixekizumab or brodalumab then guselkumab (Sequence 1) may be the most appropriate option compared with other treatments.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0307050","type":"journal-article","created":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T13:22:27Z","timestamp":1723209747000},"page":"e0307050","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sequential interleukin-17 inhibitors for moderate-to-severe plaque psoriasis who have an IL-17 inhibitors failure in a resource limited country: An economic evaluation"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6981-1771","authenticated-orcid":true,"given":"Piyameth","family":"Dilokthornsakul","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ratree","family":"Sawangjit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nopadon","family":"Noppakun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natta","family":"Rajatanavin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bensachee","family":"Pattamadilok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leena","family":"Chularojanamontri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Unchalee","family":"Permsuwan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,9]]},"reference":[{"issue":"9997","key":"pone.0307050.ref001","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/S0140-6736(14)61909-7","article-title":"Psoriasis","volume":"386","author":"WH Boehncke","year":"2015","journal-title":"Lancet"},{"issue":"4","key":"pone.0307050.ref002","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1159\/000119415","article-title":"Disease severity, quality of life and health care in plaque-type psoriasis: a multicenter cross-sectional study in Germany","volume":"216","author":"M Augustin","year":"2008","journal-title":"Dermatology"},{"issue":"3","key":"pone.0307050.ref003","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/j.1365-4632.2011.05340.x","article-title":"Quality of life and cost of illness in patients with psoriasis in Malaysia: a multicenter study","volume":"52","author":"MM Tang","year":"2013","journal-title":"Int J Dermatol"},{"issue":"4","key":"pone.0307050.ref004","first-page":"20","article-title":"Clinical and economic burden of psoriasis","volume":"19","author":"E Hazard","year":"2006","journal-title":"Manag Care Interface"},{"key":"pone.0307050.ref005","unstructured":"World Health Organization. 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