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Economic evaluation of systemic therapies for moderate to severe psoriasis

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Abstract:

Summary Background 

New biologics have dramatically changed therapeutic options for psoriasis, albeit at additional cost. Objectives 

To determine the cost-effectiveness and optimal treatment sequence for moderate to severe psoriasis. Methods 

Psoriasis Area and Severity Index (PASI) response rates from 22 randomized controlled trials evaluating biologic (adalimumab, efalizumab, etanercept, infliximab) and nonbiologic systemic (methotrexate, ciclosporin) agents were considered. Short-term efficacy was based on relative probabilities of achieving PASI response (50/75/90) in a meta-analysis of trials. Published evidence and assumptions were used to predict long-term efficacy. Treatment benefits were determined by the relationship between PASI response and the EuroQOL 5D health utility measure. Costs included therapy, administration, monitoring and hospitalization. Incremental cost-effectiveness ratios (ICERs) were calculated and treatments ranked relative to supportive care. Results 

Infliximab provided the most incremental quality-adjusted life-years (QALYs) vs. supportive care (0·18 QALYs; 95% confidence interval, CI 0·13–0·24), followed by adalimumab (0·16 QALYs; 95% CI 0·11–0·22). Methotrexate and ciclosporin were less beneficial (0·13 and 0·08 QALYs, respectively) but were cost saving and considered the first two treatments in the optimal sequence. Comparing biologics, adalimumab was most cost effective (ICER £30 000 per QALY), followed by etanercept (£37 000 per QALY), efalizumab (£40 000 per QALY) and infliximab (£42 000 per QALY). Conclusions 

Methotrexate and ciclosporin are cost effective but require monitoring for toxicities. Of the biologics, adalimumab was most cost effective following conventional systemic treatment failure or inadequate response. Payers and policymakers will have to decide how to utilize their budgets effectively for treating patients with moderate to severe psoriasis.

Keywords: adalimumab; biologics; cost-effectiveness; psoriasis; quality of life; randomized controlled trial

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-2133.2008.08962.x

Affiliations: 1: Departments of Dermatology, Pathology and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, U.S.A. 2: Global Health Economics and Outcomes Research, Abbott Laboratories, Abbott Park, IL, U.S.A. 3: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada V6T 1Z3

Publication date: June 1, 2009

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