WEDNESDAY, Feb. 25, 2026 (HealthDay News) -- For patients with moderate-to-severe plaque psoriasis, biologics offer the largest mean gains, according to a study published online Feb. 25 in JAMA Dermatology.

Edward L. Kong, Ph.D., from Harvard Medical School in Boston, and Elizabeth A. Buzney, M.D., from Brigham and Women's Hospital in Boston, compared the efficacy, quality-of-life gains, and cost-effectiveness of biologics, phototherapy, and step-therapy strategies in a simulation modeling study involving patients with moderate-to-severe plaque psoriasis. The exposures included one year of treatment with bimekizumab, narrowband UV-B phototherapy (home or office), or a step-therapy regimen involving phototherapy for 16 weeks followed by biologics if an improvement in the Psoriasis Area and Severity Index (PASI) score of ≥90 percent was not achieved.

The mean baseline PASI value was 20.2 among 500,000 simulated adult patients. The researchers found that the mean reductions in PASI were 91.6, 71.1, and 95.2 percent for biologics, phototherapy, and the step-therapy regimen, respectively. The mean quality-adjusted life-year gains were 0.24, 0.18, and 0.23 for biologics, phototherapy, and step therapy, respectively, and the mean monetized gains were $24,107, $17,916, and $22,560, respectively. The mean annual total costs were $84,034, $14,760, and $6,222 for biologics, office phototherapy, and home phototherapy, respectively; the corresponding out-of-pocket costs were $2,000, $5,004, and $1,450. Mean net willingness to pay was highest and lowest for home phototherapy and biologics, respectively ($11,694 and −$59,926, respectively) from the payer perspective. The mean willingness to pay was positive across all regimens for patients and was highest for biologics.

"These findings highlight trade-offs between efficacy, costs, and equity and underscore the misalignment between patient and payer incentives," the authors write.

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