Cost Utility Analysis Based on a Head-to-Head Phase 3 Trial Comparing Ustekinumab and Etanercept in Patients with Moderate-to-Severe Plaque Psoriasis: A Canadian Perspective

Pan, Feng; Brazier, Nicole C.; Shear, Neil H.; Jivraj, Farah; Brown, Ruth E.

doi:10.1016/j.jval.2011.01.006

Cited by 25 publications

(46 citation statements)

References 10 publications

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“…In the other five models out of 15 models that did not include an active second-line treatment, cost effectiveness was estimated over a 10-year time horizon. In these five models, discontinuation from the first-line biologic was assumed to be followed by a switch to topical treatment [13] or nonsystemic treatment [24, 25], no further active treatment [26] or best supportive care [30]. …”

Section: Resultsmentioning

confidence: 99%

Treatment Sequencing After Failure of the First Biologic in Cost-Effectiveness Models of Psoriasis: A Systematic Review of Published Models and Clinical Practice Guidelines

Mauskopf

Samuel²,

McBride³

et al. 2014

PharmacoEconomics

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ObjectivesTo analyse the treatment sequencing assumptions after failure on a first-line biologic in cost-effectiveness models of treatment of moderate to severe plaque psoriasis, and to compare them with the most recent treatment guidelines.MethodsA systematic search of MEDLINE, Embase, EconLit and the Cochrane Library databases used free text and Medical Subject Headings terms including psoriasis, biologic therapies indicated for psoriasis, and all types of economic evaluations. Two researchers performed 2-level abstract screening for articles meeting pre-specified inclusion criteria. Assumptions about treatment pathways after first-line biologic failure in the cost-effectiveness models were analysed. A second systematic search was performed for psoriasis clinical practice guidelines. Sequence assumptions were compared with treatment guideline recommendations.ResultsOf 25 cost-effectiveness modelling studies identified, ten estimated the incremental cost per responder; time horizons varied (12 weeks–18 months) and treatment sequencing was not considered. In 15 studies where treatment sequencing was considered, with time horizons up to 10 years, five studies included only a switch to nonsystemic therapy or best supportive care after first-line biologic failure. Another five of the 15 treatment-pathway studies were available only as abstracts with no details of the sequence assumptions. In five of the 15 studies, first-line biologic failure was followed by second-line biologic monotherapy, one of the recommendations in current treatment guidelines. In only one of these five studies was the efficacy of the second-line biologic adjusted downwards, compared with first-line treatment. Only one of these studies considered dose titration with a first-line biologic and none combination therapy (biologic plus methotrexate or phototherapy) after first-line biologic failure, as recommended in some treatment guidelines.ConclusionsCost-effectiveness models of first-line biologics for moderate to severe plaque psoriasis either do not include subsequent treatment regimens or include only some of the regimens recommended in current treatment guidelines. Results may be sensitive to assumptions about treatment sequencing and the choice and efficacy of subsequent treatment regimens.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-014-0130-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Treatment Sequencing After Failure of the First Biologic in Cost-Effectiveness Models of Psoriasis: A Systematic Review of Published Models and Clinical Practice Guidelines

Mauskopf

Samuel²,

McBride³

et al. 2014

PharmacoEconomics

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“…The values or changes in utility were measured by levels of PASI response in five studies [24,40,51,53,62]. Three studies mapped the Dermatology Life Quality Index (DLQI) to European Quality of Life-5 Dimensions (EQ-5D) utilities [35,57,59]; however, Woolacott et al [67] mapped the change in DLQI associated with different PASI response categories and baseline DLQI scores to changes in EQ-5D utility. The remaining studies either estimated utility values directly from study patients [22,26,58], stated utility values from previous studies were used without providing further details [43,56], or obtained utilities by response status defined by neither PASI nor DLQI from previous studies [60].…”

Section: Synthesis Of Cost-effectiveness Analysis Studiesmentioning

confidence: 99%

“…Some justification for not explicitly including the cost of adverse events was provided. For example, serious adverse events are rare with the treatments of interest [24,62], adverse event rates are similar between comparators [35,44], and it is conservative not to include the cost of adverse events [57,64,69]. In terms of the indirect costs, only one article took account of presenteeism, which is defined as reduced productivity while working due to health problems [58].…”

Section: Synthesis Of Cost-effectiveness Analysis Studiesmentioning

confidence: 99%

“…The main assumptions include patient compliance or adherence to treatments [49,60], length of treatment [31], productivity costs [58,62], hospitalization for non-responders [24,62,67], defining responders by PASI 90 (a 90 % reduction in the PASI score) [32] or PASI 50 (a 50 % reduction) [62] instead of PASI 75 (a 75 % reduction), a treatment-free response period [21], responding patients withdrawing from treatment [35,40], reduced response upon re-treatment [59], and disutility on intermittent therapy [62]. Furthermore, more than one time horizon was applied in some studies [23,32,35,40,46,48,60,71]. We found that in 20 studies, the sensitivity analyses had no impact on the final conclusions, whereas in 14 other studies, the cost-effectiveness conclusions were affected.…”

Section: Within the Studymentioning

confidence: 99%

“…For this purpose, we only focused on studies comparing the same treatments and using QALY as the effectiveness measure. Four types of comparisons were conducted by at least two studies (Table 3), and these were found to be (1) ustekinumab 45 mg every 12 weeks versus etanercept 50 mg twice weekly for 12 weeks followed by 50 mg once weekly [35,40]; (2) [62] identified the most cost-effective sequence of treatment options conditional on a threshold value of cost effectiveness. Lloyd et al [59] used PASI 50 as response criterion and also mapped DLQI to utility, whereas the latter two studies used PASI 75.…”

Section: Across Studiesmentioning

confidence: 99%

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Systematic Review of Cost-Effectiveness Analyses of Treatments for Psoriasis

Zhang

Islam

et al. 2014

PharmacoEconomics

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Decision-Analytic Modeling for Time-Effectiveness of the Sequence of Induction Treatments for Moderate to Severe Plaque Psoriasis

et al. 2019

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IMPORTANCE Systemic psoriasis treatments vary in efficacy and cost but also in time until onset of action. Patients with no response to a first induction treatment are typically switched to another, and some patients require several treatments before they see an improvement. OBJECTIVE To determine the most cost-effective sequence of induction treatment through a comparative time-effectiveness analysis of different systemic treatment sequences currently licensed in Germany for moderate to severe plaque psoriasis. DESIGN, SETTING, AND PARTICIPANTSThis time-effectiveness analysis used a decision-analytic model set in the German health care system. The population simulated to receive the treatment sequences consisted of adult men and women with psoriasis vulgaris or plaque type psoriasis eligible for systemic treatment. Systematic reviews were performed to generate model input values. Data were collected from November 1 through December 15, 2017, and analyzed from January through August 2018.INTERVENTIONS Five treatment sequences frequently used in Germany, identified through an online expert survey (response rate, 10 of 15 [66.7%]), and 4 theoretical sequences starting with a biological agent. Treatments included methotrexate sodium (MTX), cyclosporine (CSA), fumaric acid esters (FAE), adalimumab (ADA), ixekizumab (IXE), infliximab (INF), and secukinumab (SEC).MAIN OUTCOMES AND MEASURES Two health states were defined: responder (patients achieving a Psoriasis Area Severity Index [PASI] Ն75) and nonresponder (PASI <75). Probability values were defined as response rates of PASI-75. Treatment effects were determined by the mean change in Dermatology Life Quality Index (DLQI) score. Time until onset of action was assessed as weeks until 25% of patients reach PASI-75. Individual time-effectiveness ratios were calculated per treatment sequence as time until onset of action (in weeks) per minimally important difference (MID) in DLQI and were subsequently ranked. RESULTSTreatment sequences starting with a biological agent, including IXE-INF-SEC (1.4 weeks per DLQI-MID), INF-IXE-SEC (2.05 weeks per DLQI-MID), SEC-IXE-ADA (2.1 weeks per DLQI-MID), and ADA-IXE-SEC (2.8 weeks per DLQI-MID) were more time-effective than frequently used treatment sequences, including MTX-SEC-ADA (6.8 weeks per DLQI-MID), MTX-ADA-IXE (7.0 weeks per DLQI-MID), MTX-ADA-SEC (7.2 weeks per DLQI-MID), MTX-FAE-ADA (10.05 weeks per DLQI-MID), and FAE-MTX-CSA (11.5 weeks per DLQI-MID). The results were robust to deterministic sensitivity analyses.CONCLUSIONS AND RELEVANCE When allocating monetary resources, policy makers and regulators may want to consider time until patients experience an MID in their quality of life as an additional outcome measure.

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Cost Utility Analysis Based on a Head-to-Head Phase 3 Trial Comparing Ustekinumab and Etanercept in Patients with Moderate-to-Severe Plaque Psoriasis: A Canadian Perspective

Abstract: This model highlights the advantage of having head-to-head comparative trial data relevant to the at-risk population. Our model shows that ustekinumab is more cost-effective than etanercept for patients with moderate-to-severe plaque psoriasis.

Cited by 25 publications

References 10 publications

Treatment Sequencing After Failure of the First Biologic in Cost-Effectiveness Models of Psoriasis: A Systematic Review of Published Models and Clinical Practice Guidelines

Treatment Sequencing After Failure of the First Biologic in Cost-Effectiveness Models of Psoriasis: A Systematic Review of Published Models and Clinical Practice Guidelines

Systematic Review of Cost-Effectiveness Analyses of Treatments for Psoriasis

Decision-Analytic Modeling for Time-Effectiveness of the Sequence of Induction Treatments for Moderate to Severe Plaque Psoriasis

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