Efficacy and cost of etanercept in long-term psoriasis: Rational use in clinical practice

Ruiz‐Villaverde, Ricardo; Galán‐Gutiérrez, Manuel; Barabash-Neila, Román; Rodriguez‐Fernandez‐Freire, Lourdes; Conejo‐Mir, Julián

doi:10.3109/09546634.2015.1054776

Cited by 4 publications

(10 citation statements)

References 22 publications

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“…Of the partial economic evaluations for moderate–severe PSO, four ( n = 505 patients treated with ETN) were based on observational studies in a real-life clinical context [27–30], and one study used modeling techniques [31]. All of the studies adopted the perspective of the NHS (only pharmacological costs), with the exception of one cost-minimization study which also considered indirect costs owing to loss of productivity [28].…”

Section: Resultsmentioning

confidence: 99%

“…The annual cost per patient with moderate–severe PSO who was treated with ETN ranged from €4986 (maintenance phase cost in patients receiving intermittent treatment) to €12,327/patient-year (maintenance phase cost in patients receiving continuos treatment) [30]. For patients who experienced loss of response to the ETN treatment, the annual escalation cost owing to dose duplication ranged from €14,580 (12-week intensification) to €18,908 (31-week intensification)/patient-year [31] (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…The perspective in all studies but one was that of the NHS [28], which contrasts with the perspective used in another review on the overall impact of these pathologies in Europe [4] in which the social perspective was primarily used. The annual cost per PSO patient receiving ETN treatment varied widely (€4,986–€15,268/patient-year) [27, 30], resulting in an annual cost of €18,908/patient if an extension of 31 weeks of escalated treatment is considered [31], suggesting that it may be higher than the overall cost of the pathology reported in Europe (13,132 USD-PPP) [4]. In contrast to the above, the annual cost per patient reported by the only publication on the use of ETN in the treatment of PsA in Spain is significantly lower than the referenced study (€8,585/patient-year vs. €10,924–17,050 USD-PPP/patient-year) [4].…”

Section: Discussionmentioning

confidence: 99%

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Economic Impact of Etanercept in Patients with Psoriasis and Psoriatic Arthritis in Spain: A Systematic Review

Puig

Fernández‐Freire

Burgos

et al. 2019

Dermatol Ther (Heidelb)

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Introduction Etanercept (ETN), a highly effective biological agent for the treatment of psoriasis (PSO) and psoriatic arthritis (PsA), is widely used in Spain. However, evidence of its economic impact is limited, indicating the need for a systematic review of the economic assessments conducted on the use of ETN in the treatment of both PSO and PsA in Spain. Methods A systematic review was carried out in PubMed, Embase, Cochrane Library, Health Technology Assessment reports and not indexed sources up to November 2018. The inclusion criteria were economic evaluations (total and partial) and dose optimization studies published in English or Spanish on the use of ETN to treat PSO and PsA for ETN in Spain. Results A total of 402 publications were identified, of which 32 were selected for inclusion in the review; of these 32 publications, 81.3% analyzed PSO (14 full economic evaluations, 5 partial economic evaluations and 7 dose optimization studies) and 18.8% analyzed PsA (1 economic analysis and 5 dose optimization studies). The perspective of the Spanish National Health Service (NHS) was used in 90.0% ( n = 18) of the full and partial economic evaluations. The time horizons ranged from 12 weeks to 2 years. Reductions in the Psoriasis Area and Severity Index (PASI) of 50, 75 and 90% (PASI 50, 75 and 90, respectively) were most commonly used as efficacy outcomes in the complete evaluations. The economic impact of ETN ranged from €9110–14,337/PASI 75 at 12 weeks (50 mg/week) to €82,279/PASI 90 at 2 years, depending on the health outcome, time horizon and ETN dose used. Only one study determined the cost of using ETN for the treatment of PSO (€29,430–52,367/QALY for dose 2 × 25 mg/week or 50 mg/week, respectively). Only one partial economic evaluation on PSA was identified (NHS perspective), resulting in an ETN annual cost of €8585/patient-year. Conclusion Consistent evidence on the economic impact of ETN for the treatment of PSO and PSA in Spain is lacking, mainly due to the highly heterogeneous methodology used and the broad range of outcomes found in the economic evaluations published to date. Funding Pfizer S.L.U. Electronic supplementary material The online version of this article (10.1007/s13555-019-0301-6) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Economic Impact of Etanercept in Patients with Psoriasis and Psoriatic Arthritis in Spain: A Systematic Review

Puig

Fernández‐Freire

Burgos

et al. 2019

Dermatol Ther (Heidelb)

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“…For the chronic condition psoriasis, for example, Health Technology Appraisals by the UK economics watch dog NICE commonly assume greater health benefit for biologic drugs, impacting on a “value for money” type of approach for these high‐cost drugs. By contrast, we here exploit detailed knowledge of the response of psoriasis to phototherapy as well as comparator treatments in order to simplify modelling by aligning it with clinical practice: regardless of a specific PASI improvement, a given patient is likely to progress along the treatment pathway if a subjectively “insufficient” experienced level of disease control is encountered, as shown previously in detail for methotrexate . We therefore also disregard potential savings by reduced requirement for steroid cream treatment, which we have previously shown for NB‐UVB, as this specific is likely be comparable for any effective intervention.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is worth noting that we have previously shown that the degree of disease control by NB-UVB is comparable to that achieved by methotrexate under realworld conditions, 6,17,18 and that response rates are similar to clinical study results reported for apremilast, DMF and etanercept. [19][20][21] Although the subjectively experienced degree of disease control, that is the "health benefit," is likely higher using a biologic drug, it is therefore reasonable to assume that any given patient will not continue phototherapy in the absence of a subjective benefit justifying treatment attendance.…”

Section: Actual-versus Qaly-based Costsmentioning

confidence: 99%

Phototherapy achieves significant cost savings by the delay of drug‐based treatment in psoriasis

Foerster

Dawe

2019

Photoderm Photoimm Photomed

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Background Although used for decades in psoriasis, access to phototherapy is becoming increasingly restricted. Besides patient inconvenience, this is in large part to do with a perception of “high cost.” We previously reported a comprehensive analysis of direct and indirect phototherapy treatment cost. However, no robust data exist on the actual savings associated with providing phototherapy in the treatment pathway. Objectives To quantify the cost savings achieved by phototherapy by delaying alternative treatments. Methods Costs accruing through the UK‐wide established treatment pathway with and without phototherapy were analysed. Direct and indirectly incurred drug treatment costs were calculated using drug tariff, laboratory cost, estate rates and clinic review costs. To enhance reliability, ranges of cost scenarios were calculated by varying parameters such as drug dosing. Results Medium annual cost savings per patient were £2200 [range: £1800‐£2900] for NB‐UVB, and £3700 [range: £2500‐£5300] if both NB‐UVB and PUVA courses were administered, respectively. As the provider treated 656 ± 76 patients per year during the 6‐year observational window, this amounted to savings of £Mio 2.4 [range: £Mio 1.6‐£Mio 3.4], even excluding additional non‐modelled drug‐associated costs (eg diagnostics, adverse event management). Since we only consider cost savings by delay of drug treatment for the duration of phototherapy, drug price reductions through biosimilar introduction only have a small effect. We provide spreadsheets allowing adaptation cost savings projections by varying input variables. Conclusions Healthcare providers may achieve significant cost savings by implementing and/or widening access to phototherapy.

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Intermittent use of biologic agents for the treatment of psoriasis in adults

Alhammadi

Ruszczak

Magariños³

et al. 2020

Acad Dermatol Venereol

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Current clinical recommendations suggest that continuous treatment of moderate‐to‐severe psoriasis with biologic agents is more effective than intermittent treatment in terms of achieving remission and maintaining it. Intermittent treatment, however, may provide an alternative approach in patients unwilling or unable to maintain a continuous regimen, such as those who would prefer a ‘treatment vacation’ after achieving long‐term remission, those who require treatment cessation owing to adverse events, and where insurance arrangements do not provide sufficient cover for continuous treatment. We conducted a literature search of PubMed to identify publications reporting data on the efficacy and safety of intermittent treatment with biologic agents in adults with psoriasis, specifically the use of inhibitors of tumour necrosis factor (adalimumab, certolizumab pegol, etanercept and infliximab), interleukin (IL)‐12/IL‐23 (ustekinumab), IL‐23 (guselkumab) and IL‐17 (brodalumab, ixekizumab and secukinumab). From our search, we identified 18 relevant publications reporting the intermittent use of the biologic therapies of interest: five described etanercept, three described adalimumab, two each described infliximab, ixekizumab or ustekinumab, and one each described certolizumab pegol, guselkumab, brodalumab and secukinumab. In general, there were large proportions of patients (≥60%) who were able to re‐establish disease control (as defined by each study) following re‐treatment, and the safety profiles of the various agents during re‐treatment were as anticipated from their profiles observed during continuous dosing. The exception to these general findings was infliximab, which showed the lowest rate of efficacy‐endpoint achievement (25% and 38% in two dosing groups evaluated) as well as a higher incidence of adverse infusion reactions compared with continuous dosing. In conclusion, the use of biologic agents in psoriasis is changing and current clinical data suggest that intermittent treatment may provide an effective and well‐tolerated option for certain patients.

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Efficacy and cost of etanercept in long-term psoriasis: Rational use in clinical practice

Abstract: We present our experience in regular clinical practice with etanercept, showing it to be an effective, safe, and versatile drug that permits patient-tailored treatment, delivering a frankly satisfactory control of our psoriasis patients.

Cited by 4 publications

References 22 publications

Economic Impact of Etanercept in Patients with Psoriasis and Psoriatic Arthritis in Spain: A Systematic Review

Economic Impact of Etanercept in Patients with Psoriasis and Psoriatic Arthritis in Spain: A Systematic Review

Phototherapy achieves significant cost savings by the delay of drug‐based treatment in psoriasis

Intermittent use of biologic agents for the treatment of psoriasis in adults

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