Systematic Review of Cost-Effectiveness Analyses of Treatments for Psoriasis
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.
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.
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.
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.
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.
- 9.Boudreau R, Blackhouse G, Goeree R, Mierzwinski-Urban M. Adalimumab, alefacept, efalizumab, etanercept, and infliximab for severe psoriasis vulgaris in adults: budget impact analysis and review of comparative clinical-and cost-effectiveness. Ottawa: Canadian Agency for Drugs and Technology in Health; 2007. Report No. 97.Google Scholar
- 10.Mauskopf J, Samuel M, McBride D, Mallya UG, Feldman SR. Treatment sequencing after failure of the first biologic in cost-effectiveness models of psoriasis: a systematic review of published models and clinical practice guidelines. Pharmacoeconomics. 2014;32:395–409.CrossRefPubMedCentralPubMedGoogle Scholar
- 11.Glanville J, Fleetwood K, Yellowlees A, Kaunelis D, Mensinkai S. Development and testing of search filters to identify economic evaluations in MEDLINE and EMBASE. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2009. Report No. H0490.Google Scholar
- 19.Hankin CS, Bhatia ND, Goldenberg G, Bronstone A, Dunn JD. A comparison of the clinical effectiveness and cost-effectiveness of treatments for moderate to severe psoriasis. Drug Benefit Trends. 2010;22:17–27.Google Scholar
- 20.Hankin CS, Feldman SR, Szczotka A, Stinger RC, Fish LS, Hankin DL. A cost comparison of treatments of moderate to severe psoriasis. Drug Benefit Trends. 2005;17:200–14.Google Scholar
- 22.Oh P, Gupta A, Einarson T, Maerov P, Shear N. Calcipotriol in the treatment of psoriasis of limited severity: pharmacoeconomic evaluation. J Cutan Med Surg. 1997;2:7–15.Google Scholar
- 25.Bergstrom KG, Arambula K, Kimball AB. Medication formulation affects quality of life: a randomized single-blind study of clobetasol propionate foam 0.05 % compared with a combined program of clobetasol cream 0.05 % and solution 0.05 % for the treatment of psoriasis. Cutis. 2003;72:407–11.PubMedGoogle Scholar
- 47.Vano-Galvan S, Garate MT, Fleta-Asin B, Hidalgo A, Fernandez-Guarino M, Bermejo T, et al. Analysis of the cost effectiveness of home-based phototherapy with narrow-band UV-B radiation compared with biological drugs for the treatment of moderate to severe psoriasis. Actas Dermosifiliogr. 2012;103:127–37.CrossRefPubMedGoogle Scholar
- 49.Augustin M, Peeters P, Radtke M, Moehling U, Lapp C. Cost-effectiveness model of topical treatment of mild to moderate psoriasis vulgaris in Germany. A comparison of calcipotriol/betamethasone (daivobet/dovobet/taclonex) once daily and a morning/evening non-fix combination of calcipotriol and betamethasone. Dermatology. 2007;215:219–28.CrossRefPubMedGoogle Scholar
- 51.Bottomley JM, Auland ME, Morais J, Boyd G, Stewart Douglas W. Cost-effectiveness of the two-compound formulation calcipotriol and betamethasone dipropionate compared with commonly used topical treatments in the management of moderately severe plaque psoriasis in Scotland. Curr Med Res Opin. 2007;23:1887–901.CrossRefPubMedGoogle Scholar
- 67.Woolacott N, Hawkins N, Mason A, Kainth A, Khadjesari Z, Vergel YB, et al. Etanercept and efalizumab for the treatment of psoriasis: a systematic review. Health Technol Assess. 2006;10:1–233, i–iv.Google Scholar
- 68.Hakkaart-van Roijen L, Verboom P, Redekop WK, Touw KR, Rutten FF. The cost effectiveness of tapered versus abrupt discontinuation of oral cyclosporin microemulsion for the treatment of psoriasis. Pharmacoeconomics. 2001;19:599–608.Google Scholar
- 75.Harari M, Shani J, Hristakieva E, Stanimirovic A, Seidl W, Burdo A. Clinical evaluation of a more rapid and sensitive Psoriasis Assessment Severity Score (PASS), and its comparison with the classic method of Psoriasis Area and Severity Index (PASI), before and after climatotherapy at the Dead-Sea. Int J Dermatol. 2000;39:913–8.CrossRefPubMedGoogle Scholar
- 81.All Wales Medicines Strategy Group. Final appraisal report: etanercept (Enbrel®). All Wales Medicines Strategy Group; 2010.Google Scholar
- 82.National Institute for Health and Clinical Excellence. Ustekinumab for the treatment of adults with moderate to severe psoriasis. London: National Institute for Health and Clinical Excellence (NICE); 2009. Report No. 180.Google Scholar
- 83.National Institute for Health and Clinical Excellence. Infliximab for the treatment of adults with psoriasis. London: National Institute for Health and Clinical Excellence (NICE); 2008. Report No. 134.Google Scholar