The European Journal of Health Economics

, Volume 13, Issue 2, pp 145–156 | Cite as

Cost-effectiveness of treatment with etanercept for psoriasis in Sweden

  • Christopher Knight
  • Josephine Mauskopf
  • Mats Ekelund
  • Amitabh Singh
  • Shiyi Yang
  • Robert Boggs
Original Paper

Abstract

Objective

To estimate the cost-effectiveness, from a Swedish societal perspective, of intermittent use of etanercept (Enbrel) with interruptions of use after 24 weeks compared to continuous use of adalimumab (Humira) as well as non-systemic standard of care in patients with moderate to severe psoriasis.

Methods

A Markov decision-tree model was constructed from clinical trials results. Patients starting etanercept, adalimumab, or non-systemic therapy moved through the model’s 10-years horizon. Model input parameters included clinical response rates. Outcome measures included direct and indirect costs and quality-adjusted life-years (QALYs).

Results

The incremental total (direct and indirect) costs per QALY were 1,559,939 kr (€165,354) for adalimumab 40 mg every other week, compared with intermittent once-weekly Enbrel 50 mg, and 93,629 kr (€9,925) for once-weekly intermittent etanercept 50 mg compared with non-systemic standard of care.

Conclusions

This analysis showed that, with a 470,000 kr (€50,000) per QALY willingness-to-pay threshold, once-weekly etanercept 50 mg, used intermittently, is a cost-effective treatment for moderate to severe psoriasis compared with adalimumab and non-systemic standard of care.

Keywords

Cost-effectiveness Psoriasis Etanercept Adalimumab Intermittent treatment QALY 

JEL Classification

I19 

References

  1. 1.
    Christophers, E.: Psoriasis epidemiology and clinical spectrum. Clin. Exp. Dermatol 26(4), 314–320 (2001)PubMedCrossRefGoogle Scholar
  2. 2.
    Langley, R.G.B., Krueger, G.G., Griffiths, C.E.M.: Psoriasis: epidemiology, clinical features, and quality of life. Ann. Rheum. Dis 64, 18–23 (2005)CrossRefGoogle Scholar
  3. 3.
    Devrimci-Ozguven, H., Kundakci, N., Kumbasar, H., Boyvat, A.: The depression, anxiety, life satisfaction and affective expression levels in psoriasis patients. J. Eur. Acad. Dermatol. Venereol 14, 267–271 (2000)PubMedCrossRefGoogle Scholar
  4. 4.
    Ginsburg, I.H., Link, B.G.: Feelings of stigmatization in patients with psoriasis. J. Am. Acad. Dermatol 20, 53–63 (1989)PubMedCrossRefGoogle Scholar
  5. 5.
    Vardy, D., Besser, A., Amir, M., Gesthalter, B., Biton, A., Buskila, D.: Experiences of stigmatization play a role in mediating the impact of disease severity on quality of life in psoriasis patients. Br. J. Dermatol 147, 736–742 (2002)PubMedCrossRefGoogle Scholar
  6. 6.
    Richards, H.L., Fortune, D.G., Main, C.J., Griffiths, C.E.: Stigmatization and psoriasis. Br. J. Dermatol 149, 209–210 (2003)PubMedCrossRefGoogle Scholar
  7. 7.
    Finzi, A.F., Mantovani, L.G., Belisari, A., Italian Association for Studies on Psoriasis: The cost of hospital-related care of patients with psoriasis in Italy based on the AISP study. Associazione Italiana Studi Psoriasi. J. Eur. Acad. Dermatol. Venereol 15(4), 320–324 (2001)PubMedGoogle Scholar
  8. 8.
    Kugland, B., Ehlken, B., Hofmaier, A., Augustin, M., Berger, K.: Cost-of-illness study in patients suffering from chronic plaque psoriasis in Germany. PSN 8. Presented at the 6th annual European congress of international society for pharmacoeconomics and outcomes research (ISPOR). Value Health. 6(6), 786 (2003)Google Scholar
  9. 9.
    Berger, K., Ehlken, B., Kugland, B., Augustin, M.: Cost-of-illness in patients with moderate and severe chronic psoriasis vulgaris in Germany. J. der Deutschen Dermatologischen Gesellschaft 3(7), 511–518 (2005)CrossRefGoogle Scholar
  10. 10.
    Finlay, A.Y., Coles, E.C.: The effect of severe psoriasis on the quality of life of 369 patients. Br. J. Dermatol 132(2), 236–244 (1995)PubMedCrossRefGoogle Scholar
  11. 11.
    Lebwohl, M., Ali, S.: Treatment of psoriasis. Part 1. Topical therapy and phototherapy. J. Am. Acad. Dermatol 45(4), 487–498 (2001)PubMedCrossRefGoogle Scholar
  12. 12.
    Lebwohl, M., Ali, S.: Treatment of psoriasis. Part 2. Systemic therapies. J. Am. Acad. Dermatol 45(5), 649–661 (2001)PubMedCrossRefGoogle Scholar
  13. 13.
    Shikiar, R., Heffernan, M., Langley, R.G., Willian, M.K., Okun, M.M., Revicki, D.A.: Humira® treatment is associated with improvement in health-related quality of life in psoriasis: patient-reported outcomes from a phase II randomized controlled trial. J. Dermatol. Treat 18(1), 25–31 (2007)CrossRefGoogle Scholar
  14. 14.
    Gordon, K.B., Langley, R.G., Leonardi, C., Toth, D., Menter, M.A., Kang, S., et al.: Clinical response to adalimumab in patients with moderate to severe psoriasis: double-blind, randomized controlled trial and open-label extension study. J. Am. Acad. Dermatol 55, 598–606 (2006)PubMedCrossRefGoogle Scholar
  15. 15.
    Saurat, J., Stingl, G., Dubertret, L., Papp, K., Langley, R.G., Ortonne, J., et al.: Efficacy and safety results from the randomized controlled comparative study of adalimumab vs. methotrexate vs. placebo in patients with psoriasis (CHAMPION). Br. J. Dermatol 158, 558–566 (2008)PubMedCrossRefGoogle Scholar
  16. 16.
    Menter, A., Tyring, S.K., Gordon, K., Kimball, A.B., Leonardi, C.L., Langley, R.G., et al.: Adalimumab therapy for moderate to severe psoriasis: a randomized, controlled phase III trial. J. Am. Acad. Dermatol 58, 106–115 (2008)PubMedCrossRefGoogle Scholar
  17. 17.
    Papp, K., Leonard, C., Gordon, K., Okun, M.: Efficacy and safety of adalimumab in a 120-weeks open-label study in patients with moderate to severe chronic plaque psoriasis. P2777. Presented at the 65th annual meeting of the American Academy of Dermatology (2007)Google Scholar
  18. 18.
    Gordon, K.B., Gottlieb, A.B., Loenardi, C.L., Elewski, B.E., Wang, A., Jahreis, A., for the etanercept psoriasis study group, et al.: Clinical response in psoriasis patients discontinued from and then reinitiated on etanercept therapy. J. Dermatol. Treat 17, 9–17 (2006)CrossRefGoogle Scholar
  19. 19.
    Papp, K.A., Tyring, S., Lahfa, M., Prinz, J., Griffiths, C.E.M., Nakanishi, A.M., Zitnik, R., van de Kerkhof, P.C.M., for the Etanercept Psoriasis Study Group: A global phase III randomized controlled trial of etanercept in psoriasis: safety, efficacy, and effect of dose reduction. Br. J. Dermatol 152, 1304–1312 (2005)PubMedCrossRefGoogle Scholar
  20. 20.
    Leonardi, C.L., Powers, J.L., Matheson, R.T., Goffe, B.S., Zitnik, R., Wang, A., Gottlieb, A.B., Etanercept Psoriasis Study Group: Etanercept as monotherapy in patients with psoriasis. N. Engl. J. Med 349(21), 2014–2022 (2003)PubMedCrossRefGoogle Scholar
  21. 21.
    van de Kerkhof, P.C.M., Segaert, S., Lahfa, M., Luger, T.A., Karolyi, Z., Kaszuba, A., et al.: Once weekly administration of etanercept 50 mg is efficacious and well tolerated in patients with moderate-to-severe plaque psoriasis: a randomized controlled trial with open-label extension. Br. J. Dermatol 159, 1177–1185 (2008)PubMedGoogle Scholar
  22. 22.
    Finlay, A.Y.: Current severe psoriasis and the rule of tens. Br. J. Dermatol 152, 861–867 (2005)PubMedCrossRefGoogle Scholar
  23. 23.
    Swedish Pharmaceutical Benefits Board. www.lfn.se. Accessed 2 Apr 2008
  24. 24.
    Recommended treatments for psoriasis by the Stockholm county council: http://www.vardguiden.se/Article.asp?ArticleID=5251 Accessed 15 Aug 2007
  25. 25.
    Etanercept and efalizumab for the treatment of psoriasis: a systematic review. Health Technol. Assess. 10(46), 1–252 (2006). http://www.york.ac.uk/inst/crd/projects/psoriasis.htm
  26. 26.
    Regional prices and re-numeration rates for the southern health care region http://www.skane.se/templates/Page.aspx?id=190940 (2008)
  27. 27.
    Ds 2002:49 Den svenska sjukan—sjukfrånvaron i åtta olika länderGoogle Scholar
  28. 28.
  29. 29.
    Diagnoses in In-patient Care 1998–2006 [database on the Internet]. Stockholm: The National Board of Health and Welfare. [Cited May 12 2008]. Available from: http://www.socialstyrelsen.se/en/Statistics/Statistical_databases.htm
  30. 30.
    Tennvall, G.R., Bergman, A., Bjarnason, A., Hjelmgren, J., Hjortsberg, C., Svensson, A.: Behandlingsmönster, resursanvändning, kostnader och livskvalitet relaterat till psoriasis—Resultat från en svensk patientenkät och journalgenomgång. Studien presenteras på Svenska Läkaresällskapets Riksstämma i Stockholm (2009)Google Scholar
  31. 31.
    Newcombe, R.G.: Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat. Med 17, 857–872 (1998)PubMedCrossRefGoogle Scholar
  32. 32.
    Wilson, E.B.: Probable inference, the law of succession, and statistical inference. J. Am. Stat. Assoc 22, 209–221 (1927)CrossRefGoogle Scholar
  33. 33.
    Briggs, A.H., Ades, A.E., Price, M.J.: Probabilistic sensitivity analysis for decision trees with multiple branches: use of the Dirichlet distribution in a Bayesian framework. Med. Decis. Mak 23, 341–350 (2003)CrossRefGoogle Scholar
  34. 34.
    Woolacott, N., Bravo, V.Y., Hawkins, N., Kainth, A., Khadjesari, Z., Misso, K., et al.: Etanercept and infliximab for the treatment of psoriatic arthritis: a systematic review and economic evaluation. Health Technol. Assess 10(31), iii–iv, xiii–xvi, 1–239 (2006)Google Scholar
  35. 35.
    Gospodarevskaya, E., Picot, J., Cooper, K., Loveman, E., Takeda, K.: Ustekinumab for the treatment of moderate to severe psoriasis. Health Technol. Assess 13, 61–66 (2009)PubMedGoogle Scholar
  36. 36.
    XE Currency Conversion Website http://www.xe.com/ucc/. Accessed 6 Apr 2008
  37. 37.
    Socialstyrelsen. Nationella riktlinjer för prostatacancersjukvård. Medicinskt och hälsoekonomiskt faktadokument. 2007 (Swedish). Available at http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/8946/2007-102-8_20071029.pdf. Accessed Aug 2009
  38. 38.
    Papp, K., Parish, L.C., Gu, Y., Goldblum, O., Okun, M.: Efficacy Outcomes for Patients with Psoriasis who Interrupt Adalimumab Therapy. Presented at European Academy of Dermatology and Venereology, Paris (2008)Google Scholar
  39. 39.
    Patel, V., Horn, E.J., Lobosco, S.J., Fox, K.M., Stevens, S.R., Lebwohl, M.: Psoriasis treatment patterns: results of a cross-sectional survey of dermatologists. J. Am. Acad. Dermatol 58, 964–969 (2008)PubMedCrossRefGoogle Scholar
  40. 40.
    Leonardi, C.L., Elewski, B.E., Camisa, C., Wang, A.T., Zitnik, R.J.: The efficacy and safety of etanercept in the retreatment of psoriasis after relapse. In: Proceedings of the American Academy of Dermatology, Jul–Aug, New York (2004)Google Scholar
  41. 41.
    Fleischmann, R., Stern, R., Iqbal, I.: Etanercept-review of efficacy and safety after five years of clinical use. Therapy 1(1), 11–23 (2004)Google Scholar
  42. 42.
    Patel, T., Gordon, K.B.: Adalimumab: efficacy and safety in psoriasis and rheumatoid arthritis. Dermatol. Therapy 17, 427–431 (2004)CrossRefGoogle Scholar
  43. 43.
    Raychaudhuri, S.P., Nguyen, C.T., Raychaudhuri, S.K., Gershwin, M.E.: Incidence and nature of infectious disease in patients treated with anti-TNF agents. Autoimmun. Rev 9, 67–81 (2009)PubMedCrossRefGoogle Scholar
  44. 44.
    Xavier Lymphoma, rheumatoid arthritis, and TNF-alpha antagonists (editorial). Jt. Bone Spine (in press)Google Scholar
  45. 45.
    Krueger, G.G., Elewski, B., Papp, K., Wang, A., Zitnik, R., Jahreis, A.: Patients with psoriasis respond to continuous open-label etanercept treatment after initial incomplete response in a randomized, placebo-controlled trial. J. Am. Acad. Dermatol 54, S112–S119 (2006)PubMedCrossRefGoogle Scholar
  46. 46.
    Lloyd, A., Reeves, P., Conway, P., Reynolds, A., Baxter, G.: Economic evaluation of etanercept in the management of chronic plaque psoriasis. Br. J. Dermatol 160, 380–386 (2009)PubMedCrossRefGoogle Scholar
  47. 47.
    Nelson, A.A., Pearce, D.J., Fleischer, A.B., Balkrishnan, R., Feldman, S.R.: Cost-effectiveness of biologic treatments for psoriasis based on subjective and objective efficacy measures assessed over a 12-weeks treatment period. J. Am. Acad. Dermatol 58, 125–135 (2008)PubMedCrossRefGoogle Scholar
  48. 48.
    Sizto, S., Bansback, N., Feldman, S.R., Willian, M.K., Anis, A.H.: Economic evaluation of systemic therapies for moderate to severe psoriasis. Br. J. Dermatol. Epub (2008)Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Christopher Knight
    • 1
  • Josephine Mauskopf
    • 2
  • Mats Ekelund
    • 3
  • Amitabh Singh
    • 4
  • Shiyi Yang
    • 4
  • Robert Boggs
    • 4
  1. 1.RTI Health Solutions, Velocity House Business and Conference CentreSheffieldUK
  2. 2.RTI Health SolutionsResearch Triangle ParkUSA
  3. 3.Pfizer Inc.SolnaSweden
  4. 4.Pfizer Inc.CollegevilleUSA

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