, Volume 33, Issue 4, pp 327–340 | Cite as

Systematic Review of Cost-Effectiveness Analyses of Treatments for Psoriasis

  • Wei Zhang
  • Nazrul Islam
  • Canice Ma
  • Aslam H. Anis
Systematic Review



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.

Supplementary material

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Supplementary material 1 (DOCX 66 kb)
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Supplementary material 3 (DOCX 89 kb)


  1. 1.
    Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133:377–85.CrossRefPubMedGoogle Scholar
  2. 2.
    Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999;41:401–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Yu AP, Tang J, Xie J, Wu EQ, Gupta SR, Bao Y, et al. Economic burden of psoriasis compared to the general population and stratified by disease severity. Curr Med Res Opin. 2009;25:2429–38.CrossRefPubMedGoogle Scholar
  4. 4.
    Lowes MA, Bowcock AM, Krueger JG. Pathogenesis and therapy of psoriasis. Nature. 2007;445:866–73.CrossRefPubMedGoogle Scholar
  5. 5.
    Gudjonsson JE, Elder JT. Psoriasis: epidemiology. Clin Dermatol. 2007;25:535–46.CrossRefPubMedGoogle Scholar
  6. 6.
    Dvorakova V, Markham T. Psoriasis: current treatment options and recent advances. Prescriber. 2013;24:13–20.CrossRefGoogle Scholar
  7. 7.
    Rich SJ, Bello-Quintero CE. Advancements in the treatment of psoriasis: role of biologic agents. J Manag Care Pharm. 2004;10:318–25.PubMedGoogle Scholar
  8. 8.
    Bhosle MJ, Feldman SR, Camacho FT, Timothy Whitmire J, Nahata MC, Balkrishnan R. Medication adherence and health care costs associated with biologics in Medicaid-enrolled patients with psoriasis. J Dermatol Treat. 2006;17:294–301.CrossRefGoogle Scholar
  9. 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. 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. 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
  12. 12.
    Chiou C-F, Hay JW, Wallace JF, Bloom BS, Neumann PJ, Sullivan SD, et al. Development and validation of a grading system for the quality of cost-effectiveness studies. Med Care. 2003;41:32–44.CrossRefPubMedGoogle Scholar
  13. 13.
    Drummond MF, Jefferson TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party. BMJ. 1996;313:275–83.CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Glennie JL, Torrance GW, Baladi JF, Berka C, Hubbard E, Menon D, et al. The revised Canadian guidelines for the economic evaluation of pharmaceuticals. Pharmacoeconomics. 1999;15:459–68.CrossRefPubMedGoogle Scholar
  15. 15.
    Drummond MF, Richardson WS, O’Brien BJ, Levine M, Heyland D. Users’ guides to the medical literature: XIII. How to use an article on economic analysis of clinical practice A. Are the results of the study valid? JAMA. 1997;277:1552–7.CrossRefPubMedGoogle Scholar
  16. 16.
    O’Brien BJ, Heyland D, Richardson WS, Levine M, Drummond MF. Users’ guides to the medical literature: XIII. How to use an article on economic analysis of clinical practice B. What are the results and will they help me in caring for my patients? JAMA. 1997;277:1802–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Wong WB, Carlson JJ, Thariani R, Veenstra DL. Cost effectiveness of pharmacogenomics. Pharmacoeconomics. 2010;28:1001–13.CrossRefPubMedGoogle Scholar
  18. 18.
    Ofman JJ, Sullivan SD, Neumann PJ, Chiou CF, Henning JM, Wade SW, et al. Examining the value and quality of health economic analyses: implications of utilizing the QHES. J Manag Care Pharm. 2003;9:53–61.PubMedGoogle Scholar
  19. 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. 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
  21. 21.
    Menter A, Baker T. Cost-efficacy analysis of biological treatments in psoriasis: an 18-month assessment. J Med Econ. 2005;8:139–46.CrossRefGoogle Scholar
  22. 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
  23. 23.
    Ahn CS, Gustafson CJ, Sandoval LF, Davis SA, Feldman SR. Cost effectiveness of biologic therapies for plaque psoriasis. Am J Clin Dermatol. 2013;14:315–26.CrossRefPubMedGoogle Scholar
  24. 24.
    Anis AH, Bansback N, Sizto S, Gupta SR, Willian MK, Feldman SR. Economic evaluation of biologic therapies for the treatment of moderate to severe psoriasis in the United States. J Dermatol Treat. 2011;22:65–74.CrossRefGoogle Scholar
  25. 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
  26. 26.
    Chen S, Shaheen A, Garber A. Cost-effectiveness and cost-benefit analysis of using methotrexate vs Goeckerman therapy for psoriasis: a pilot study. Arch Dermatol. 1998;134:1602–8.PubMedGoogle Scholar
  27. 27.
    Ellis CN, Reiter KL, Bandekar RR, Fendrick AM. Cost-effectiveness comparison of therapy for psoriasis with a methotrexate-based regimen versus a rotation regimen of modified cyclosporine and methotrexate. J Am Acad Dermatol. 2002;46:242–50.CrossRefPubMedGoogle Scholar
  28. 28.
    Feldman SR, Garton R, Averett W, Balkrishnan R, Vallee J. Strategy to manage the treatment of severe psoriasis: considerations of efficacy, safety and cost. Expert Opin Pharmacother. 2003;4:1525–33.CrossRefPubMedGoogle Scholar
  29. 29.
    Liu Y, Wu EQ, Bensimon AG, Fan CP, Bao Y, Ganguli A, et al. Cost per responder associated with biologic therapies for Crohn’s disease, psoriasis, and rheumatoid arthritis. Adv Ther. 2012;29:620–34.CrossRefPubMedGoogle Scholar
  30. 30.
    Marchetti A, Feldman SR, Kimball AB, Anderson RR, Miller LH, Martin J, et al. Treatments for mild-to-moderate recalcitrant plaque psoriasis: expected clinical and economic outcomes for first-line and second-line care. Dermatol Online J. 2005;11:1.PubMedGoogle Scholar
  31. 31.
    Marchetti A, LaPensee K, An P. A pharmacoeconomic analysis of topical therapies for patients with mild-to-moderate stable plaque psoriasis: a US study. Clin Ther. 1998;20:851–69.CrossRefPubMedGoogle Scholar
  32. 32.
    Martin S, Feldman SR, Augustin M, Szapary P, Schenkel B. Cost per responder analysis of ustekinumab and etanercept for moderate to severe plaque psoriasis. J Dermatol Treat. 2011;22:138–43.CrossRefGoogle Scholar
  33. 33.
    Nelson AA, Pearce DJ, Fleischer AB, Balkrishnan R, Feldman SR. New treatments for psoriasis: which biologic is best? J Dermatol Treat. 2006;17:96–107.CrossRefGoogle Scholar
  34. 34.
    Nelson AA, Pearce DJ, Fleischer AB Jr, Balkrishnan R, Feldman SR. Cost-effectiveness of biologic treatments for psoriasis based on subjective and objective efficacy measures assessed over a 12-week treatment period. J Am Acad Dermatol. 2008;58:125–35.CrossRefPubMedGoogle Scholar
  35. 35.
    Pan F, Brazier NC, Shear NH, Jivraj F, Schenkel B, Brown R. Cost utility analysis based on a head-to-head phase 3 trial comparing ustekinumab and etanercept in patients with moderate-to-severe plaque psoriasis: a Canadian perspective. Value Health. 2011;14:652–6.CrossRefPubMedGoogle Scholar
  36. 36.
    Pearce DJ, Nelson AA, Fleischer AB, Balkrishnan R, Feldman SR. The cost-effectiveness and cost of treatment failures associated with systemic psoriasis therapies. J Dermatol Treat. 2006;17:29–37.CrossRefGoogle Scholar
  37. 37.
    Poulin Y, Langley RG, Teixeira HD, Martel MJ, Cheung S. Biologics in the treatment of psoriasis: clinical and economic overview. J Cutan Med Surg. 2009;13(Suppl 2):S49–57.CrossRefPubMedGoogle Scholar
  38. 38.
    Staidle JP, Dabade TS, Feldman SR. A pharmacoeconomic analysis of severe psoriasis therapy: a review of treatment choices and cost efficiency. Expert Opin Pharmacother. 2011;12:2041–54.CrossRefPubMedGoogle Scholar
  39. 39.
    Stern RS. The benefits, costs and risks of topical tar preparations in the treatment of psoriasis: considerations of cost effectiveness. Ann Acad Med Singap. 1988;17:473–6.PubMedGoogle Scholar
  40. 40.
    Villacorta R, Hay JW, Messali A. Cost effectiveness of moderate to severe psoriasis therapy with etanercept and ustekinumab in the United States. Pharmacoeconomics. 2013;31:823–39.CrossRefPubMedGoogle Scholar
  41. 41.
    Blasco AJ, Lazaro P, Ferrandiz C, Garcia-Diez A, Liso J. Efficiency of biologic agents in the treatment of moderate to severe psoriasis. Actas Dermosifiliogr. 2009;100:792–803.CrossRefPubMedGoogle Scholar
  42. 42.
    De Argila D, Rodriguez-Nevado I, Chaves A. Cost-effectiveness analysis comparing methotrexate with PUVA therapy for moderate–severe psoriasis in the sanitary area of Badajoz. Actas Dermosifiliogr. 2007;98:35–41.CrossRefPubMedGoogle Scholar
  43. 43.
    Colombo GL, Di Matteo S, Peris K, Fargnoli MC, Esposito M, Mazzotta A, et al. A cost-utility analysis of etanercept for the treatment of moderate-to-severe psoriasis in Italy. Clin Outcomes Res. 2009;1:53–9.CrossRefGoogle Scholar
  44. 44.
    Colombo GL, Di Matteo S, Bruno G, Girolomoni G, Vena GA. Calcipotriol and betamethasone dipropionate in the treatment of mild-to-moderate psoriasis: a cost-effectiveness analysis of the ointment versus gel formulation. Clin Outcomes Res. 2012;4:261–8.CrossRefGoogle Scholar
  45. 45.
    Harrington C. Cost-effectiveness analysis of calcipotriol ointment and “short-contact” dithranol in treating mild-to-moderate psoriasis. Br J Med Econ. 1995;8:27–32.CrossRefGoogle Scholar
  46. 46.
    De Portu S, Del Giglio M, Altomare G, Arcangeli F, Berardesca E, Pinton PC, et al. Cost-effectiveness analysis of TNF-α blockers for the treatment of chronic plaque psoriasis in the perspective of the Italian health-care system. Dermatol Ther. 2010;23:S7–13.CrossRefPubMedGoogle Scholar
  47. 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
  48. 48.
    Ashcroft DM, Li Wan Po A, Williams HC, Griffiths CE. Cost-effectiveness analysis of topical calcipotriol versus short-contact dithranol. In the treatment of mild to moderate plaque psoriasis. Pharmacoeconomics. 2000;18:469–76.CrossRefPubMedGoogle Scholar
  49. 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
  50. 50.
    Augustin M, Radtke M, van Engen A, Ruedig C, Lapp C, Moehling U. Pharmacoeconomic model of topical treatment options of mild to moderate psoriasis vulgaris in Germany. J Dtsch Dermatol Ges. 2009;7:329–38.PubMedGoogle Scholar
  51. 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
  52. 52.
    Ferrandiz C, Garcia A, Blasco AJ, Lazaro P. Cost-efficacy of adalimumab, etanercept, infliximab and ustekinumab for moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol. 2012;26:768–77.CrossRefPubMedGoogle Scholar
  53. 53.
    Freeman K, Marum M, Bottomley JM, Auland M, Jackson P, Ryttov J. A psoriasis-specific model to support decision making in practice: UK experience. Curr Med Res Opin. 2011;27:205–23.CrossRefPubMedGoogle Scholar
  54. 54.
    Greiner RA, Braathen LR. Cost-effectiveness of biologics for moderate-to-severe psoriasis from the perspective of the Swiss healthcare system. Eur J Dermatol. 2009;19:494–9.PubMedGoogle Scholar
  55. 55.
    Hartman M, Prins M, Swinkels OQ, Severens JL, De Boo T, Van Der Wilt GJ, et al. Cost-effectiveness analysis of a psoriasis care instruction programme with dithranol compared with UVB phototherapy and inpatient dithranol treatment. Br J Dermatol. 2002;147:538–44.CrossRefPubMedGoogle Scholar
  56. 56.
    Heinen-Kammerer T, Daniel D, Stratmann L, Rychlik R, Boehncke WH. Cost-effectiveness of psoriasis therapy with etanercept in Germany. J Dtsch Dermatol Ges. 2007;5:762–8.CrossRefPubMedGoogle Scholar
  57. 57.
    Knight C, Mauskopf J, Ekelund M, Singh A, Yang S, Boggs R. Cost-effectiveness of treatment with etanercept for psoriasis in Sweden. Eur J Health Econ. 2012;13:145–56.CrossRefPubMedGoogle Scholar
  58. 58.
    Koek MB, Sigurdsson V, van Weelden H, Steegmans PH, Bruijnzeel-Koomen CA, Buskens E. Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study). BMJ. 2010;340:c1490.CrossRefPubMedCentralPubMedGoogle Scholar
  59. 59.
    Lloyd A, Reeves P, Conway P, Reynolds A, Baxter G. Economic evaluation of etanercept in the management of chronic plaque psoriasis. Br J Dermatol. 2009;160:380–6.CrossRefPubMedGoogle Scholar
  60. 60.
    Sawyer L, Samarasekera EJ, Wonderling D, Smith CH. Topical therapies for the treatment of localized plaque psoriasis in primary care: a cost-effectiveness analysis. Br J Dermatol. 2013;168:1095–105.CrossRefPubMedGoogle Scholar
  61. 61.
    Schmitt-Rau K, Rosenbach T, Radtke MA, Augustin M. Cost-effectiveness of biological therapy in remission induction of moderate to severe plaque psoriasis. Dermatology. 2010;221:236–42.CrossRefPubMedGoogle Scholar
  62. 62.
    Sizto S, Bansback N, Feldman SR, Willian MK, Anis AH. Economic evaluation of systemic therapies for moderate to severe psoriasis. Br J Dermatol. 2009;160:1264–72.CrossRefPubMedGoogle Scholar
  63. 63.
    Snellman E, Maljanen T, Aromaa A, Reunanen A, Jyrkinen-Pakkasvirta T, Luoma J. Effect of heliotherapy on the cost of psoriasis. Br J Dermatol. 1998;138:288–92.CrossRefPubMedGoogle Scholar
  64. 64.
    Papp K, Poulin Y, Barber K, Lynde C, Prinz JC, Berg M, et al. Cost-effectiveness evaluation of clobetasol propionate shampoo (CPS) maintenance in patients with moderate scalp psoriasis: a Pan-European analysis. J Eur Acad Dermatol Venereol. 2012;26:1407–14.CrossRefPubMedGoogle Scholar
  65. 65.
    Peeters P, Ortonne JP, Sitbon R, Guignard E. Cost-effectiveness of once-daily treatment with calcipotriol/betamethasone dipropionate followed by calcipotriol alone compared with tacalcitol in the treatment of psoriasis vulgaris. Dermatology. 2005;211:139–45.CrossRefPubMedGoogle Scholar
  66. 66.
    Devaux S, Castela A, Archier E, Gallini A, Joly P, Misery L, et al. Topical vitamin D analogues alone or in association with topical steroids for psoriasis: a systematic review. J Eur Acad Dermatol Venereol. 2012;26:52–60.CrossRefPubMedGoogle Scholar
  67. 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. 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
  69. 69.
    Aggarwal K, Khandpur S, Khanna N, Sharma VK, Pandav CS. Comparison of clinical and cost-effectiveness of psoralen + ultraviolet A versus psoralen + sunlight in the treatment of chronic plaque psoriasis in a developing economy. Int J Dermatol. 2013;52:478–85.CrossRefPubMedGoogle Scholar
  70. 70.
    Shani J, Harari M, Hristakieva E, Seidl V, Bar-Giyora J. Dead-Sea climatotherapy versus other modalities of treatment for psoriasis: comparative cost-effectiveness. Int J Dermatol. 1999;38:252–62.CrossRefPubMedGoogle Scholar
  71. 71.
    Igarashi A, Kuwabara H, Fahrbach K, Schenkel B. Cost-efficacy comparison of biological therapies for patients with moderate to severe psoriasis in Japan. J Dermatol Treat. 2013;24:351–5.CrossRefGoogle Scholar
  72. 72.
    Kerkhof PCM. On the limitations of the psoriasis area and severity index (PASI). Br J Dermatol. 1992;126:205–6.CrossRefPubMedGoogle Scholar
  73. 73.
    Jacobson CC, Kimball AB. Rethinking the Psoriasis Area and Severity Index: the impact of area should be increased. Br J Dermatol. 2004;151:381–7.CrossRefPubMedGoogle Scholar
  74. 74.
    Feldman SR, Fleischer AB, Reboussin DM, Rapp SR, Exum ML, Clark AR, et al. The self-administered psoriasis area and severity index is valid and reliable. J Invest Dermatol. 1996;106:183–6.CrossRefPubMedGoogle Scholar
  75. 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
  76. 76.
    Menter MA, Krueger GC, Feldman SR, Weinstein GD. Psoriasis treatment 2003 at the new millennium: position paper on behalf of the authors. J Am Acad Dermatol. 2003;49:39–43.CrossRefGoogle Scholar
  77. 77.
    Carlin CS, Feldman SR, Krueger JG, Menter A, Krueger GG. A 50 % reduction in the Psoriasis Area and Severity Index (PASI 50) is a clinically significant endpoint in the assessment of psoriasis. J Am Acad Dermatol. 2004;50:859–66.CrossRefPubMedGoogle Scholar
  78. 78.
    Räsänen P, Roine E, Sintonen H, Semberg-Konttinen V, Ryynänen O-P, Roine R. Use of quality-adjusted life years for the estimation of effectiveness of health care: a systematic literature review. Int J Technol Assess Health Care. 2006;22:235–41.CrossRefPubMedGoogle Scholar
  79. 79.
    Schmitt JM, Ford DE. Work limitations and productivity loss are associated with health-related quality of life but not with clinical severity in patients with psoriasis. Dermatology (Basel Switz). 2006;213:102–10.CrossRefGoogle Scholar
  80. 80.
    Pearce DJ, Singh S, Balkrishnan R, Kulkarni A, Fleischer AB, Feldman SR. The negative impact of psoriasis on the workplace. J Dermatol Treat. 2006;17:24–8.CrossRefGoogle Scholar
  81. 81.
    All Wales Medicines Strategy Group. Final appraisal report: etanercept (Enbrel®). All Wales Medicines Strategy Group; 2010.Google Scholar
  82. 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. 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

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Wei Zhang
    • 1
    • 2
  • Nazrul Islam
    • 1
    • 2
  • Canice Ma
    • 1
  • Aslam H. Anis
    • 1
    • 2
  1. 1.Centre for Health Evaluation and Outcome Sciences, St. Paul’s HospitalVancouverCanada
  2. 2.School of Population and Public Health, University of British ColumbiaVancouverCanada

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