Long-Term Cost-Effectiveness Analysis of Etanercept and Adalimumab for Plaque Psoriasis not Associated with Arthritis

Abstract

IntroductionPharmacoeconomic studies examining the cost-effectiveness of biological agents to treat moderate-to-severe psoriasis in real-life clinical practice are scarce. The aim of this study was to assess the efficiency, in terms of incremental cost-effectiveness, of etanercept and adalimumab in a real clinical setting.MethodsDirect and indirect costs were assessed from a Spanish societal perspective in a historical hospital cohort of patients with moderate-to-severe psoriasis attending a tertiary referral hospital over a 1-year period. The data examined included drug-related variables, use of health-care resources, transportation and work productivity losses. Effectiveness was measured as the proportion of patients achieving a reduction of at least 75% with respect to the baseline value for the Psoriasis Area Severity Index (PASI 75) during the first 52 weeks of treatment.ResultsNo statistically significant differences in effectiveness between etanercept (n = 135) and adalimumab (n = 48) were found (PASI 75 80% vs. 85.7%; RR = 1.07 [0.90, 1.27]; RRA = 5.7 [−8.9, 20.2]; p = 0.943). There were no significant differences in total cost per patient with etanercept as compared to adalimumab (14,843.73 ± 6,178.98 € vs. 15,405.91 ± 9,106.50 €; p = 0.768).ConclusionUnder conditions of daily clinical practice in our hospital, total health-care costs associated with the treatment of moderate-to-severe psoriasis with etanercept appear to be equivalent to those with adalimumab in the first year of treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-013-0030-1) contains supplementary material, which is available to authorized users.

Efficacy and cost of etanercept in long-term psoriasis: Rational use in clinical practice

“…Our study clearly demonstrates the difference between patients that do continuous therapy versus intermittent therapy, with differences of close to E2000 and E7300 in the first and the second year between both regimens. However, the use of tailored treatment strategies such as the induction dose of 50 mg/ weekly allow us to achieve costs lower than those of other hospitals in our setting (21). Etanercept, together with adalimumab, and by virtue of their posology, permits greater therapeutic flexibility, leading to lower costs, as asserted by Puig in his study published in 2013, and even without significant differences in terms of efficacy between both drugs, as substantiated by Ruano (21).…”

Biologicals and small molecules in psoriasis: A systematic review of economic evaluations

“…More than half of all studies met between 20 and 25 checklist items [ 28 – 30 , 32 – 37 , 39 , 41 , 42 , 48 , 49 , 51 – 54 , 57 , 60 , 62 , 64 , 66 , 69 , 71 , 72 , 74 , 76 , 77 , 79 ], reflecting an overall moderate quality ( S3 and S4 Tables).…”

Psoriasis treatment and management - a systematic review of full economic evaluations

“…). Twenty‐eight articles were published after the reviews that were conducted to inform the U.K.'s National Institute of Health and Care Excellence (NICE) guidelines for high‐quality psoriasis care . There was diversity in setting, perspective and national characteristics (Table ), psoriasis severity, design and evaluation type (Table S1; see Supporting Information).…”

“…Seven articles (14 of 71 comparisons) either did not specify disease severity or reported a mild to severe range. Chronic plaque psoriasis, the most common form, was considered in 13 articles (23 of 71 comparisons) . The remainder did not report the form of psoriasis.…”

“…This reflects trial designs that did not reflect routine practice or identify differences in outcomes relevant to patients, adherence and side‐effects over the lifetime course of psoriasis. A few studies addressed these issues using observational nonrandomized designs, postal survey or incorporation of long‐term safety monitoring data . It is unclear whether these designs were sufficient to minimize bias and accurately identify statistically valid differences between interventions.…”