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

• Published in: PloS one 2018-01, Vol.13 (1), p.e0189765-e0189765
• Main Authors: Kromer, Christian, Celis, Daniel, Sonntag, Diana, Peitsch, Wiebke K
• Format: Article
• Language: English
• Subjects: Analysis; Antibodies, Monoclonal, Humanized - economics; Antibodies, Monoclonal, Humanized - therapeutic use; Authorship; Biological effects; Biological products; Biological treatment; Biology and Life Sciences; Care and treatment; Complications and side effects; Cost analysis; Cost control; Cost-Benefit Analysis; Dermatology; Documents; Dosage and administration; Economic aspects; Engineering and Technology; Evaluation; Health care; Health care expenditures; Heterogeneity; Humans; Immunotherapy; Infliximab; Medicine and Health Sciences; Monoclonal antibodies; Mortality; Preventive medicine; Psoriasis; Psoriasis - drug therapy; Public health; Quality; Quality of life; Quality-Adjusted Life Years; Research and Analysis Methods; Reviews; Sensitivity analysis; Social Sciences; Studies; Systematic review; Tumor necrosis factor-α; Ustekinumab
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0189765

Biological therapy for moderate-to-severe psoriasis is highly effective but cost-intensive. This systematic review aimed at analyzing evidence on the cost-effectiveness of biological treatment of moderate-to-severe psoriasis. A literature search was conducted until 30/06/2017 in PubMed, Cochrane Library, LILACS, and EconLit. The quality of identified studies was assessed with the checklist by the Centre for Reviews and Dissemination guidance. Out of 482 records, 53 publications were eligible for inclusion. Half of the studies met between 20 and 25 of the quality checklist items, displaying moderate quality. Due to heterogeneity of studies, a qualitative synthesis was conducted. Cost ranges per outcome were enormous across different studies due to diversity in assumptions and model design. Pairwise comparisons of biologicals revealed conflicting results. Overall, adalimumab appeared to be most cost-effective (100% of all aggregated pairwise comparisons), followed by ustekinumab (66.7%), and infliximab (60%). However, in study conclusions most recent publications favored secukinumab and apremilast (75% and 60% of the studies investigating these medications). Accepted willingness-to-pay thresholds varied between 30,000 and 50,000 USD/Quality-Adjusted Life Year (QALY). Three-quarters of studies were financially supported, and in 90% of those, results were consistent with the funder's interest. Economic evaluation of biologicals is crucial for responsible allocation of health care resources. In addition to summarizing the actual evidence this review highlights gaps and needs for future research.