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 Jan;58(1):125-35. doi: 10.1016/j.jaad.2007.09.018. Epub 2007 Nov 8.

Abstract

Background: The cost-effectiveness of biologic agents is not well delineated.

Objective: To determine the cost-effectiveness of biologic agents in cost per patient achieving a minimally important difference in Dermatology Life Quality Index (DLQI MID) and cost per patient achieving a 75% improvement in Psoriasis Area Severity Index (PASI-75), assessed over a 12-week period.

Method: Efficacies of the agents were determined through a literature review; treatment paradigms and associated costs were determined. The cost-effectiveness of the agents was determined and sensitivity analysis performed.

Results: Etanercept at a dose of 25 mg administered subcutaneously (SQ) once weekly was the most cost-effective agent in cost per patient achieving DLQI minimally important difference; infliximab at a dose of 3 mg/kg administered intravenously (IV) for 3 infusions, adalimumab at a dose of 40 mg SQ every other week, and etanercept at a dose of 25 mg SQ twice weekly were the next most cost-effective agents in cost per patient achieving the DLQI minimally important difference. Intravenous infliximab at a dose of 3 mg/kg was the most cost-effective agent in terms of cost per patient achieving PASI-75 improvement; intravenous infliximab at a dose of 5 mg/kg and adalimumab at a dose of 40 mg SQ every other week were the next most cost-effective agents in cost per patient achieving PASI-75 improvement.

Limitations: This study had a limited time horizon of 12 weeks; generalizing the results to longer treatment periods may not be accurate and is not advisable. Additionally, when sensitivity analyses were performed, multiple agents had overlapping cost-effectiveness ratios at relatively low levels of variance; thus it may not be accurate to differentiate the cost-effectiveness of these agents.

Conclusions: Different biologic agents for psoriasis appear to have different cost-effectiveness values; within the limitations of the available data, infliximab and adalimumab appear to be the most cost-effective agents.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adalimumab
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / economics*
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized
  • Cost-Benefit Analysis
  • Dose-Response Relationship, Drug
  • Drug Costs*
  • Etanercept
  • Humans
  • Immunoglobulin G / administration & dosage
  • Immunoglobulin G / economics*
  • Immunoglobulin G / therapeutic use
  • Infliximab
  • Injections, Intravenous
  • Injections, Subcutaneous
  • Psoriasis / drug therapy*
  • Psoriasis / physiopathology
  • Quality of Life
  • Receptors, Tumor Necrosis Factor / administration & dosage
  • Receptors, Tumor Necrosis Factor / therapeutic use
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Infliximab
  • Adalimumab
  • Etanercept