Impact of Low Adherence On Cost-Effectiveness Of The Biological Treatment of Psoriasis (PSO) And Psoriatic Arthritis (PSA) In Slovenia

OBJECTIVES: To evaluate the impact of low adherence in patients with psoriasis (PsO) and psoriatic arthritis (PsA) treated with biological therapy (adalimumab) in Slovenia. METHODS: Flexible Markov state transition cohort models were adapted using locally-specific data separately for each indication...

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Bibliographic Details
Published in:Value in health 2017-10, Vol.20 (9), p.A558
Main Authors: Hren, R, Milanic, M
Format: Article
Language:English
Subjects:
Adherence
Arthritis
Clinical research
Clinical trials
Cost analysis
Economics
Medical treatment
Monoclonal antibodies
Patient compliance
Patients
Pharmacology
Psoriasis
Psoriatic arthritis
Quality adjusted life years
Questionnaires
Robustness
Sensitivity analysis
Severity
Suffering
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Summary:OBJECTIVES: To evaluate the impact of low adherence in patients with psoriasis (PsO) and psoriatic arthritis (PsA) treated with biological therapy (adalimumab) in Slovenia. METHODS: Flexible Markov state transition cohort models were adapted using locally-specific data separately for each indication taking into account the complexity of treatment pathways in PsO and PsA. Health states within both models were assessed either on the basis of Psoriasis Area Severity Index for PsO or Psoriatic Arthritis Response Criteria and Health Assessment Questionnaire for PsA. Adalimumab was compared with best supportive care (BSC) following the design of clinical trials and requirement that the cost-effectiveness of adalimumab is appraised in a conservative manner. RESULTS: In patients suffering from PsO, the treatment with adalimumab when compared to BSC resulted in ICER of 611.005 per QALY for full (100%) adherence, and €62.711 per QALY for real-life (50%) adherence. In patients suffering from PsA resulting ICER was €16.313 per QALY for full (100%) adherence and £37.865 per QALY for real-life (50%) adherence. Even the adherence that is often deemed satisfactory (75%) had pronounced effect on cost-effectivenss of treament with adalimumab when compared to BSC (ICER of €33.954 per QALY for PsO and €26.948 per QALY for PsA). The sensitivity analysis showed robustness of findings in both groups of patients. CONCLUSIONS: Our pharmacoeconomic analysis inidicates that cost-effectiveness is markedly altered by low adherence to the treatment with adalimumab in patients suffering from PsO and PsA. The findings of our study have potential implications for introduction of adherence-enhancing interventions.
ISSN:1098-3015
1524-4733
DOI:10.1016/j.jval.2017.08.907