Health Equity and Secukinumab for Severe Psoriasis in New Zealand

Abstract

Background/Objectives

The only funded indication in New Zealand between October 2018 and April 2021 for the biologic secukinumab, an interleukin-17A antibody, was severe psoriasis. This unique period of limited availability of secukinumab allowed the evaluation of who received it and health equity.

Methods

Anonymised dispensing data were obtained from the New Zealand Ministry of Health and matched with the New Zealand deprivation index, ethnicity and census data.

Results

Compared to the most socio-economically deprived, the least deprived were significantly more likely to receive secukinumab, respectively, dispensing rates per 100,000 (95% confidence interval) 4.00 (3.29–4.71) and 6.56 (5.61–7.51) p < 0.0001. Compared to European ethnicity, Māori, Pacific peoples and Asian were less likely to receive secukinumab, respectively, dispensing rates per 100,000 (95% confidence interval) 6.30 (5.81–6.79), 3.27 (2.56–3.99), 3.31 (2.28–4.33), 4.33 (3.48–5.19) p < 0.0001 all groups.

Conclusions

Between October 2018 and April 2021, the data suggest that the dispensing of secukinumab was inequitable. Those having severe psoriasis and being socio-economically disadvantaged or of Māori, Pacific and Asian compared to European ethnicity, were significantly less likely to have received secukinumab. Dermatologist workforce shortages in New Zealand are likely to compound the problem.