Topical therapies for the treatment of localized plaque psoriasis in primary care: a cost-effectiveness analysis

Abstract

SummaryBackground Topical therapies are a mainstay of psoriasis treatment, but they vary substantially in terms of cost. Objectives To determine the cost-effectiveness and optimal treatment sequence for psoriasis of the trunk, limbs and scalp. Methods Probabilities of response from a network meta-analysis were used to determine the short-term efficacy of topical therapies. Longer-term outcomes, including relapse, were informed by published evidence and clinical opinion. Benefits of treatment were measured as quality-adjusted life years (QALYs). Direct costs included topical agents, primary and secondary care visits and second-line therapies for treatment failures. Results For the trunk and limbs, initial treatment with a two-compound formulation (TCF) product containing vitamin D and potent corticosteroid provided the most QALYs, followed by separate morning and evening application of vitamin D and potent corticosteroid [two-compound application, TCA (am/pm)], and then twice-daily potent corticosteroids. The use of twice-daily potent corticosteroids was the most cost-effective first-line strategy (incremental cost-effectiveness ratio £20 000 per QALY), followed by TCA (am/pm) (£22 658 per QALY) and TCF product (£179 439 per QALY). For scalp psoriasis, initial treatment with very potent corticosteroids generated the most QALYs, followed by TCF product and then potent corticosteroids. Very potent corticosteroids were the most costeffective treatment but, if too aggressive, potent corticosteroids were optimal followed by TCF product (£219 846 per QALY). The cost-effectiveness of second-and third-line topical agents varied with the assumptions made. Conclusions Potent corticosteroids, used alone or in combination with vitamin D, are the most cost-effective treatment for patients with psoriasis of the trunk and limbs. Potent or very potent corticosteroids are the most cost-effective treatment for patients with scalp psoriasis.

Psoriasis treatment and management - a systematic review of full economic evaluations

“…). Twenty‐eight articles were published after the reviews that were conducted to inform the U.K.'s National Institute of Health and Care Excellence (NICE) guidelines for high‐quality psoriasis care . There was diversity in setting, perspective and national characteristics (Table ), psoriasis severity, design and evaluation type (Table S1; see Supporting Information).…”

“…There was diversity in setting, perspective and national characteristics (Table ), psoriasis severity, design and evaluation type (Table S1; see Supporting Information). Fifteen papers reported more than one type of comparison. In total, 71 comparisons between different interventions were reported.…”

“…Sixteen articles (35 of 71 comparisons) evaluated therapies marketed by the research funder. Four articles (eight of 71 comparisons) were publicly funded. Of the 16 articles (26 of 71 comparisons) not specifying a funding source, about a third of these (six of 16 papers) were authored by employees of a pharmaceutical company or the health system …”

Systematic Review of Cost-Effectiveness Analyses of Treatments for Psoriasis

“…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].…”

“…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.…”