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Systematic Review of Cost-Effectiveness Analyses of Treatments for Psoriasis

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Abstract

Background

Psoriasis is a chronic inflammatory disease of the skin that has a major effect on an individual’s physical and mental function. The disease is associated with increased healthcare resource use and costs, therefore cost-effectiveness analysis (CEA) can be used to assist decision makers with determining which treatments are optimal within a constrained healthcare system budget.

Objectives

Our aim was to systematically review the current literature on the CEA of existing treatment options for psoriasis, assess the quality of these studies, and summarize the evidence on the drivers of cost effectiveness.

Methods

A literature search using Medical Subject Headings and keywords was performed in the MEDLINE, EMBASE and Health Technology Assessment databases, as well as the National Health Service Economic Evaluation Database; the CEA Registry was searched using keywords only. All references within the relevant review articles were examined manually. Two researchers independently determined the final articles and a third researcher resolved any discrepancies. We evaluated study quality in terms of the study perspective, effectiveness measures, cost measures, economic model, and time horizon. Any sensitivity analyses conducted in the studies were examined to identify the drivers of cost effectiveness, which included any variables leading to changes in the study conclusions.

Results

Fifty-three articles were included in our final review: 70 % did not explicitly include costs related to adverse events; approximately one-quarter used quality-adjusted life-years; and 34 % applied a time horizon under 1 year. In 18 of the 38 studies that conducted a sensitivity analysis, the cost-effectiveness results were impacted by uncertainty. The main key drivers of cost effectiveness were the costs related to the treatment, values and choice of efficacy, utility values, hospitalization for non-responders, time horizon, model structure, and utility mapping method.

Conclusions

High-quality cost-effectiveness studies are required to facilitate resource allocation decision making. To improve study quality, future research should provide evidence on the long-term experience with psoriasis treatments, and resolve the uncertainty associated with key drivers of cost effectiveness.

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Acknowledgments

Wei Zhang is a recipient of the Michael Smith Foundation for Health Research Postdoctoral Fellowship Award. Nazrul Islam acknowledges support from the Canadian Institutes of Health Research through the Vanier Canada Graduate Scholarship.

Conflicts of interest

No funding has been received for the conduct of this study and/or preparation of this manuscript. Wei Zhang, Nazrul Islam, and Canice Ma declare no conflicts of interest regarding the formation of this review. Aslam Anis reports receiving grants from AbbVie Corporation and Pfizer Inc. outside the submitted work, as well as personal fees from AbbVie Corporation, Pfizer Inc., International Federation of Psoriasis Association, and International Value Coalition (via the European Accreditation Council for Continuing Medical Education).

Authors’ contributions

Wei Zhang contributed to the study rationale and design, quality assessment of identified studies, reviewing of sensitivity analyses and identification of key drivers, interpretation and reflection, and drafting and reviewing of the manuscript. Nazrul Islam assisted in the literature search, literature selection, quality assessment of identified studies, interpretation and reflection, and critically reviewing and revising the manuscript for important intellectual contributions. Canice Ma assisted in the literature selection, quality assessment of identified studies, and critically reviewing and revising the manuscript for important intellectual contributions. Aslam Anis contributed to the study rationale and design, interpretation and reflection, and critically reviewing and revising the manuscript for important intellectual contributions. All authors reviewed and approved the final manuscript. Wei Zhang and Aslam Anis are guarantors of the study.

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  1. Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Wei Zhang, Nazrul Islam, Canice Ma & Aslam H. Anis

  2. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Wei Zhang, Nazrul Islam & Aslam H. Anis

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  1. Wei Zhang
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Correspondence to Aslam H. Anis.

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Zhang, W., Islam, N., Ma, C. et al. Systematic Review of Cost-Effectiveness Analyses of Treatments for Psoriasis. PharmacoEconomics 33, 327–340 (2015). https://doi.org/10.1007/s40273-014-0244-9

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