33266 Optimizing treatment cost for psoriasis patients: Oral vs. subcutaneous methotrexate

Abstract

Background: Methotrexate (MTX) is a therapeutic option before, or in conjunction with, biologic therapy in psoriasis. Evidence suggests that subcutaneous (SC) MTX is underused by dermatologists as a treatment for moderate-severe psoriasis compared with oral MTX. There is evidence that SC MTX is superior to oral MTX in regard to bioavailability, effectiveness, and gastrointestinal side effects at or above 15 mg weekly. The yearly medication cost of MTX in 1993 was $458.01 (dose and route not noted) and $393.00 per year in 2010 at 15 mg/week oral dose. This study seeks to determine the relative cost difference between the 2 formulations. Methods: Using the website SingleCare (www.singlecare.com), we obtained the available self-pay prices of SC MTX (2 vials of 50 mg/2 mL) and oral MTX (24 tablets of 2.5 mg) at 371 different pharmacies across all 50 states in the U.S and compared the prices for 1 year of therapy at 15 mg/week. Results: With cost of syringes, needles and alcohol pads added, SC MTX has significantly lower yearly cost compared with oral MTX. Oral MTX was found to cost an average of $338/year, while SC MTX was found to cost $134.68/year (P < .001). Both forms of methotrexate would have additional costs of therapy including provider visits, laboratory work monitoring, and possible liver biopsy. Conclusions: When considering the cost of methotrexate therapy, SC MTX seems to be significantly less expensive than oral MTX therapy.