Blasco AJ, Lázaro P, Ferrándiz C, García-Díez A, Liso J
Efficiency of Biologic Agents in the Treatment of Moderate to Severe Psoriasis. [JOURNAL ARTICLE]
Actas Dermosifiliogr 2009 Nov; 100(9):792-803.
BACKGROUND: In the treatment of psoriasis, biologic agents are more expensive than conventional therapy while showing similar or superior efficacy. However, their efficiency in terms of cost/efficacy (cost perresponder in clinical trial conditions) is unknown.
OBJECTIVE. To estimate the cost/efficacy ratios of adalimumab, etanercept, infliximab, and efalizumab in the management of moderate to severe psoriasis.
MATERIAL AND METHODS: A model for the costs analysis was elaborated by building a decision tree for each of thetreatments for which scientific evidence was available.The payer perspective (Spanish national health system) wasused, only considering drug costs.The efficacy (proportion of patients who respond according to Psoriasis AreaSeverity Index [PASI] 75 criterion) was assigned according to the results of the clinical trials. When more than1 trial was available per treatment, a meta-analysis was undertaken. In the case of weight-dependent dosing, theweight of the study participants was adjusted by age and sex to the standard Spanish population with correctionfor increased weight in individuals with psoriasis. Uncertainty was investigated with a sensitivity analysis. Results and
CONCLUSIONS: Assigning the efficacy reported in the 15 published clinical trials, the most efficientbiologic agent in terms of the cost/efficacy ratio was adalimumab, with one PASI 75 response at a cost of euro8,013. For the remaining biologic agents and with different regimens,the cost per responder ranged from euro9,370 to euro17,112. The sensitivity analysis confirmed the robustness of these figures.
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