An Economic Evaluation of The Budget Impact of Precision Medicine Testing for The Treatment of Psoriasis

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Jashin Wu
Paul W Montgomery III
Blake Long
Tobin Dickerson
Margaret Snyder
Martyn Gross
Lena Chaihorsky
Hannah Mamuszka
Mike Fried


budget impact, percision medicine, psoriasis, cost savings, biologics, wasted-spend


Objective: This study was a budget impact analysis based on a budget impact model (BIM) and formularies from different commercial payer types (excluding Medicare and Medicaid). The primary objective of this study was to determine the potential cost savings utilizing precision medicine testing of biologics in patients with psoriasis. The evaluation projects the predicted cost savings of multiple formulary scenarios, simulated through the BIM.

Methods: A budget impact model was constructed to simulate the impact of Mind.Px, a transcriptomic predictive precision medicine test that can discriminate between psoriasis responders and non-responders, on psoriasis drug usage. This model simulated the impact of Mind.Px on different formularies and cost scenarios, considering the efficacy of individual biologics. All formularies used were acquired from the Policy Reporter database.

Results: Several payers representing a spectrum of covered lives populations were used to simulate the impact of Mind.Px through the budget impact model. The budget impact model returned cost savings as low as $5,138 annually to as high as $13,141 annually. Based on the analysis of this subset of payers, the model yielded average cost savings of $8,492 annually as well as an average wasted spend savings of $16,567. All Savings are represented on an annual per patient basis.

Conclusions: These savings demonstrate the potential cost savings that precision medicine testing can provide to ease the economic burden on payers, clinics/hospital systems, and patients, and may fill the need for a better method to prescribe drugs for the treatment of psoriasis.



1. Mehrmal S, Uppal P, Nedley N, Giesey RL, Delost GR. The global, regional, and national burden of psoriasis in 195 countries and territories, 1990 to 2017: A systematic analysis from the Global Burden of Disease Study 2017. J Am Acad Dermatol. 2021;84(1):46-52.

2. Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol. 2017;31(2):205-212. doi:10.1111/jdv.13854

3. Brezinski EA, Dhillon JS, Armstrong AW. Economic Burden of Psoriasis in the United States: A Systematic Review. JAMA Dermatol. 2015;151(6):651-658. doi:10.1001/jamadermatol.2014.3593

4. Wu JJ, Feldman S, Rastogi S. Comparison of the Cost-Effectiveness of Biologic Drugs Used for Moderate-to-Severe Psoriasis Treatment in the United States. Journal of Dermatological Treatment. 2018.

5. Liu J, Thatiparthi A, Martin A, Egeberg A, Wu JJ, Prevalence of Psoriasis Among Adults in the U.S. 2009-2010 and 2013-2014 National Health and Nutrition Examination Surveys. Journal of the American Academy of Dermatology (2020), doi:

6. Evans C. Managed Care Aspects of Psoriasis and Psoriatic Arthritis. American Journal of Managed Care. 2016. 22:S238-S243

7. Pilon D, Teeple A, Zhdanava M, et al. The economic burden of psoriasis with high comorbidity among privately insured patients in the United States. J Med Econ. 2019;22(2):196-203. doi:10.1080/13696998.2018.1557201

8. Arthur M. Institute for health metrics and evaluation. Nursing Standard. 2014.

9. Verbelen M, Weale ME, Lewis CM. Cost-effectiveness of pharmacogenetic-guided treatment: are we there yet?. Pharmacogenomics J. 2017;17(5):395-402. doi:10.1038/tpj.2017.21

10. Faruque F, Noh H, Hussain A, Neuberger E, Onukwugha E. Economic Value of Pharmacogenetic Testing for Cancer Drugs with Clinically Relevant Drug-Gene Associations: A Systematic Literature Review. J Manag Care Spec Pharm. 2019;25(2):260-271. doi:10.18553/jmcp.2019.25.2.260

11. U.S. Bureau of Labor Statistics, Consumer Price Index for All Urban Consumers: Medical Care in U.S. City Average [CPIMEDSL], retrieved from FRED, Federal Reserve Bank of St. Louis;, December 30, 2020.

12. Decision Resource Group (DRG), Market Forecast Dashboard Psoriasis 2018 – 2028. April 2020.

13. Cimzia [package insert]. Smyrna, GA: UCB, Inc; 2016.

14. Published 2021. Accessed September 1, 2020.

15. Enbrel [package insert]. Thousand Oaks, CA: Immunex Corporation; 2012.

16. Published 2020. Accessed September 1, 2020.

17. Erelzi [package insert]. Princeton, NJ: Sandoz Inc.; 2016.

18. Published 2020. Accessed September 1, 2020.

19. Humira [package insert]. North Chicago, IL: AbbVie Inc.; 2018.

20. Published 2020. Accessed September 9, 2020.

21. Inflectra [package insert]. Lake Forest, IL: Hospira; 2016.

22. Remicade [package insert]. Horsham, PA: Janssen Biotech Inc.; 2013.

23. Renflexis [package insert]. Kenilworth, NJ: Merch Sharp & Dohme Corp.; 2017.

24. Cosentyx [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corp.; 2016.

25. Siliq [package insert]. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; 2017.

26. Taltz [package insert]. Indianapolis, IN: Eli Lilly and Company; 2017.

27. Published 2020. Accessed September 1, 2020.

28. Ilumya [package insert]. Whitehouse Station, NJ: Merck & Co., Inc.; 2018.

29. Ilumya Prices, Coupons & Patient Assistance Programs - Published 2020. Accessed September 1, 2020.

30. Skyrizi [package insert]. North Chicago, IL: AbbVie Inc.; 2019.

31. Stelara [package insert]. Horsham, PA: Janssen Biotech, Inc.; 2016.

32. Tremfya [package insert]. Horsham, PA: Horsham, PA; 2017.

33. Menter A, Strober B, Personal Communication, October 16, 2020.

34. Chaihorsky L, Fried M, Long B, Mamuszka H, Harrington T, Lukazewski A,. Modeling the impact and value of a Precision Medicine approach from a payer perspective: an economic evaluation of stratifying rheumatoid arthritis patients for response to anti-TNF inhibitors prior to treatment. JMCP. 2021

35. Wu JJ, Pelletier C, Ung B, Tian M, Khilfeh I, Curtis JR. Real-world switch patterns and healthcare costs in biologic-naive psoriasis patients initiating apremilast or biologics. J Comp Eff Res. 2020;9(11):767-779. doi:10.2217/cer-2020-0045

36. No DJ, Inkeles MS, Amin M, Wu JJ. Drug survival of biologic treatments in psoriasis: a systematic review. J DermatologTreat. 2018;29(5):460-466. doi:10.1080/09546634.2017.1398393

37. Wu JJ, Armstrong AW, Gordon KB, Menter MA. Practical Strategies for Optimizing Management of Psoriasis. Semin Cutan Med Surg. 2018;37(2S):S52-S55. doi:10.12788/j.sder.2018.012

38. Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58(5):826- 850. doi: 10.1016/j.jaad.2008.02.039

39. Enos, C. W., O’Connell, K. A., Harrison, R. W., McLean, R. R., Dube, B., & Van Voorhees, A. S. (2021). Psoriasis severity, comorbidities and treatment response differ among geographic regions in the united states. JID Innovations, 100025.