Abstract
Biological therapy for moderate-to-severe psoriasis is highly effective but cost-intensive. This systematic review aimed at analyzing evidence on the cost-effectiveness of biological treatment of moderate-to-severe psoriasis. A literature search was conducted until 30/06/2017 in PubMed, Cochrane Library, LILACS, and EconLit. The quality of identified studies was assessed with the checklist by the Centre for Reviews and Dissemination guidance. Out of 482 records, 53 publications were eligible for inclusion. Half of the studies met between 20 and 25 of the quality checklist items, displaying moderate quality. Due to heterogeneity of studies, a qualitative synthesis was conducted. Cost ranges per outcome were enormous across different studies due to diversity in assumptions and model design. Pairwise comparisons of biologicals revealed conflicting results. Overall, adalimumab appeared to be most cost-effective (100% of all aggregated pairwise comparisons), followed by ustekinumab (66.7%), and infliximab (60%). However, in study conclusions most recent publications favored secukinumab and apremilast (75% and 60% of the studies investigating these medications). Accepted willingness-to-pay thresholds varied between 30,000 and 50,000 USD/Quality-Adjusted Life Year (QALY). Three-quarters of studies were financially supported, and in 90% of those, results were consistent with the funder’s interest. Economic evaluation of biologicals is crucial for responsible allocation of health care resources. In addition to summarizing the actual evidence this review highlights gaps and needs for future research.
Highlights
Psoriasis is a chronic inflammatory disease of the skin and joints with a prevalence of 1–3% world-wide [1], varying between different ethnicities and geographical regions [2, 3]
A total of 47 studies reported the source of effectiveness estimates [28,29,30,31,32,33,34,35,36,37,38,39,40,41,42, 48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79], and in nearly two-thirds of them, further information on methods of synthesis or design and result was provided [28, 30, 31, 33,34,35,36, 38, 40, 48, 52, 54, 55, 58,59,60, 63,64,65,66, 69,70,71,72,73,74, 78, 79]
Synthesis of cost-effectiveness resulted in enormous intervals with distinct overlap, precluding meaningful comparison between biologicals
Summary
Psoriasis is a chronic inflammatory disease of the skin and joints with a prevalence of 1–3% world-wide [1], varying between different ethnicities and geographical regions [2, 3]. A recent Swedish study showed increased direct cost (+1,365 USD) and indirect costs (+ 3,319 USD) per patient with psoriasis per year, compared with the general population. Several systematic reviews have been carried out to compare the cost-effectiveness of psoriasis treatments in general [15,16,17], as well as biological therapies in particular [18, 19]. This systematic review aims at collecting and synthesizing the available evidence on economic evaluations of biologicals for treatment of moderate-to-severe psoriasis, including newly approved biologicals and the small molecule apremilast.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
