Cost-Effectiveness of Biological Therapy in Remission Induction of Moderate to Severe Plaque Psoriasis

Abstract

Background: The introduction of biological agents has considerably changed the treatment of moderate to severe psoriasis. So far only limited data on their cost-effectiveness exist. Objective: Determination of the cost-effectiveness of biologicals from a German third payer’s perspective, assessed over a 12-week period. Methods: Efficacies of the biologicals were determined by a literature review. Treatment modalities were taken from the European S3 psoriasis guideline. Costs were calculated on the basis of the German physicians’ fee schedule. Cost-effectiveness was determined and a sensitivity analysis performed. Results: Infliximab at a dose of 3 mg/kg was the most cost-effective agent, directly followed by adalimumab, infliximab 5 mg/kg and ustekinumab. The least cost-effective agent was etanercept 2 × 50 mg/week. Sensitivity analysis showed considerable overlap of the cost-effectiveness ratios. Conclusion: Under the conditions of the German health care system, biological agents for psoriasis differ in their cost-effectiveness ratios. Differences are small, however. A major limitation of the study is the short time horizon of 12 weeks.

Older anti-TNF-αagents: why not group them for common indications in the EU?

“…1 Five of the seven studies finally selected focused on Ps, [11][12][13][14][15] two on RA [16,17] ( Table 2). How the alternatives were evaluated varied a lot in Ps: three studies compared the three anti-TNF-α antagonists against placebo [13,14] or supportive care, [15] one directly with each other, [12] the last only ADA with ETN. [11] In the two RA studies, ADA, ETN and IFL-alone [16] or in co-therapy with methotrexate [16,17]-were compared with traditional antirheumatic drugs.…”

“…[11] In the two RA studies, ADA, ETN and IFL-alone [16] or in co-therapy with methotrexate [16,17]-were compared with traditional antirheumatic drugs. Three studies on Ps included a cost-effectiveness analysis, [12][13][14] the two on RA [16,17] and one more on Ps [11] a cost-utility, the remainder on Ps both techniques. [15] Five studies took a third-party payer's viewpoint, [12][13][14][15]17] the other two a societal perspective.…”

“…Three studies on Ps included a cost-effectiveness analysis, [12][13][14] the two on RA [16,17] and one more on Ps [11] a cost-utility, the remainder on Ps both techniques. [15] Five studies took a third-party payer's viewpoint, [12][13][14][15]17] the other two a societal perspective. [11,16] The two studies on RA [16,17] and the most recent on Ps [11] adopted long-term Markov models; three studies on Ps short-term horizons (max.…”

“…[11,16] The two studies on RA [16,17] and the most recent on Ps [11] adopted long-term Markov models; three studies on Ps short-term horizons (max. 48 weeks) based on "decision trees" [12][13][14] referred to the clinical trials from which they sourced efficacy; the remaining study on Ps [15] was based on a Markov model and adopted an unclear "average year" derived from a mix of trials.…”

“…The majority of studies sourced drug efficacy mainly from clinical trials conducted on one of the three anti-TNF-α antagonists, [11][12][13][14][15]17] only one from a patients' registry. [16] Two studies on Ps [11,15] included all health-care costs except those due to adverse events, two [12,14] limited their analysis to the outpatient costs, the remainder [13] to drugs only; the two studies on RA [16,17] included all health-care costs, one of them [16] the direct non-health-care costs too.…”