Cost-effectiveness of biologic treatments for psoriasis based on subjective and objective efficacy measures assessed over a 12-week treatment period

• Published in: Journal of the American Academy of Dermatology 2008, Vol.58 (1), p.125-135
• Main Authors: Nelson, Andrew A., MD, Pearce, Daniel J., MD, Fleischer, Alan B., MD, Balkrishnan, Rajesh, PhD, Feldman, Steven R., MD, PhD
• Format: Article
• Language: English
• Subjects: Adalimumab; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - economics; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Biological and medical sciences; Cost-Benefit Analysis; Dermatology; Dose-Response Relationship, Drug; Drug Costs; Etanercept; Humans; Immunoglobulin G - administration & dosage; Immunoglobulin G - economics; Immunoglobulin G - therapeutic use; Infliximab; Injections, Intravenous; Injections, Subcutaneous; Medical sciences; Psoriasis - drug therapy; Psoriasis - physiopathology; Psoriasis. Parapsoriasis. Lichen; Quality of Life; Receptors, Tumor Necrosis Factor - administration & dosage; Receptors, Tumor Necrosis Factor - therapeutic use; Treatment Outcome
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2007.09.018

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.