Methods: Markov modelling was used to estimate ten-year incremental costs and QALYs for two treatment strategies following partial response [PASI ≥ 50 and < 75] to ustekinumab dosed every twelve weeks. Patients either continued on ustekinumab at an 'optimized' dosing of every eight weeks (45mg and 90mg) or 'switched' to anti-TNF treatment. Lack of published RCT data for second-line response to anti-TNFs resulted in the conservative selection of infliximab (a highly efficacious anti-TNF) to represent the anti-TNF class. Patients transitioned between 'Response' (higher utility) and 'Best Supportive Care' health states. Response (defined as PASI≥ 75) rates in a 26 week trial period were: ustekinumab 45mg = 44%, 90mg = 55% (n= 91 and n = 75 respectively, PHOENIX trials); anti-TNF class = 72%, (n= 94, EXPRESS II bio-experienced infliximab patients). Real world evidence informed treatment specific drug survival rates. Costs included biologics, supportive treatments, outpatient and inpatient care, and lost productivity. Input variables were subject to deterministic and probabilistic testing. Costs and QALYs were discounted at 5% p.a. and the ICER was used to compare strategies. Results: In a probabilistic incremental analysis anti-TNF treatment was less costly per patient

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