PSS10 Cost-Effectiveness of Proactive Management Versus Reactive Management with Calcipotriol/Betamethasone Dipropionate Foam for Treatment of Psoriasis Vulgaris in the UK

Abstract

The cost-effectiveness of proactive twice-weekly application of fixed-dose combination calcipotriol (Cal; 50 μg/g) plus betamethasone dipropionate (BD; 0.5 mg/g Cal/BD) foam was assessed in patients with psoriasis vulgaris. This approach reduces the rate of relapses and improves patients’ quality of life (QoL). A Markov model included three health states over a series of 4-weeks cycles for a 52 weeks’ time-horizon. Efficacy and QoL (EQ-5D-5L-PSO) were based on data from the phase III trial (NCT02899962), PSO-LONG, in which responders to a 4-week open-label phase with once-daily application of Cal/BD foam were randomized to proactive management (twice-weekly Cal/BD foam) or reactive management (twice-weekly vehicle). In both groups, relapses were treated with Cal/BD foam once-daily for 4 weeks. Costs of drug acquisition of Cal/BD foam, next-line treatments according to UK clinical guidelines and healthcare resource utilization, including physician visits, were included. In the model, patients with proactive management were estimated to have 15% lower drug usage per treatment day compared to reactive management based on Body Surface Area (BSA) measurement from PSO-LONG. In this study, the average BSA over the 52 weeks maintenance phase was a ratio of 0.85 based on an Area Under the Curve post-hoc analysis. The validated model took a UK National Health Service (NHS) perspective and in addition to the base case analysis, scenarios, one-way deterministic and probabilistic sensitivity analyses were undertaken. Using direct costs, Cal/BD foam used proactively dominated over Cal/BD foam used reactively. Proactive management was also dominant or cost-effective for the UK NHS, using NICE’s willingness-to-pay threshold, when several scenarios were conducted. These scenarios included changing the time-horizon to five years, varying the number of physician visits, using different next-line treatment assumptions and taking a societal perspective. Proactive management of psoriasis patients with Cal/BD foam is a cost-effective option compared to reactive management.