RESUMEN
BACKGROUND: Psoriasis patients experience physical and emotional burdens, which may lead to work-related productivity loss. This loss carries professional and financial repercussions. It is unknown whether the extent of psoriasis affects work absenteeism. OBJECTIVE: This study aims to compare work absenteeism between employed adults with mild versus moderate-to-severe psoriasis. METHODS: A national, cross-sectional study using the 2009 to 2019 Medical Expenditure Panel Survey evaluated 5,209,956 (weighted) adults aged ≥ 22 years. Work absenteeism was compared between adults with mild (4,521,687 weighted) and moderate-to-severe psoriasis (688,269 weighted). RESULTS: Work absenteeism, as measured by the average number of episodes per year that someone was absent from work for at least a half day, was significantly higher in patients with moderate-to-severe psoriasis than in patients with mild disease (4.4 episodes vs 2.8 episodes, P=0.002). Multivariable logistic regression models showed moderate-to-severe patients were 2.68 times more likely (95% CI:1.72-4.21; P<0.001) to take a half-day or more off from work than those with mild disease after adjusting for age, sex, race, ethnicity, poverty, cognitive limitations, insurance, education, and comorbidities. CONCLUSION: Disease severity directly impacts work absenteeism in psoriasis patients. Early diagnosis and treatment with appropriate therapies are needed to reduce disease severity and limit economic loss and professional ramifications associated with psoriasis. J Drugs Dermatol. 2024;23(8):640-644. doi:10.36849/JDD.7550.
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Absentismo , Costo de Enfermedad , Psoriasis , Índice de Severidad de la Enfermedad , Humanos , Psoriasis/economía , Psoriasis/epidemiología , Psoriasis/psicología , Femenino , Masculino , Estudios Transversales , Adulto , Persona de Mediana Edad , Adulto Joven , Estados Unidos/epidemiología , AncianoRESUMEN
BACKGROUND: Biologics has been known to be effective for patients with psoriasis. However, optimal treatment pathways and their cost-effectiveness are limited in a resource-limited country. This study assessed the cost-effectiveness of different sequential biologics for moderate-to-severe plaque psoriasis. METHOD: A hybrid model from a societal perspective was used. Model inputs were derived from network meta-analysis, clinical trials, and published literature. Three different sequential biologic treatments were assessed; Sequence 1; 1st Interleukin-17 (IL-17) inhibitor (secukinumab) followed by 2nd IL-17 inhibitors (ixekizumab or brodalumab), then 3rd IL-23 inhibitor (guselkumab), Sequence 2; ixekizumab followed by secukinumab or brodalumab, then guselkumab, and Sequence 3; brodalumab followed by ixekizumab or secukinumab, then guselkumab. Methotrexate or ciclosporin was used as standard of care (SoC). RESULTS: All three different sequential biologic therapies could gain total quality-adjusted life year (QALY), but they had higher cost than SoC. Sequence 1 had the lowest incremental cost-effectiveness ratio (ICER) compared to SoC at 621,373 THB/QALY (19,449 $/QALY). ICER for Sequence 2 was 957,258 THB/QALY (29,962 $/QALY), while that for Sequence 3 was 1,332,262 THB/QALY (41,700 $/QALY). Fully incremental analysis indicated that Sequence 3 was dominated by Sequence 1 and Sequence 2. ICER for Sequence 2 was 7,206,104 THB/QALY (225,551 $/QALY) when compared to Sequence 1. CONCLUSION: At the current willingness-to-pay of 160,000 THB/QALY, no sequential IL-17 inhibitor was cost-effective compared to SoC. Secukinumab followed by ixekizumab or brodalumab then guselkumab (Sequence 1) may be the most appropriate option compared with other treatments.
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Anticuerpos Monoclonales Humanizados , Análisis Costo-Beneficio , Interleucina-17 , Psoriasis , Humanos , Psoriasis/tratamiento farmacológico , Psoriasis/economía , Anticuerpos Monoclonales Humanizados/uso terapéutico , Anticuerpos Monoclonales Humanizados/economía , Interleucina-17/antagonistas & inhibidores , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales/economía , Años de Vida Ajustados por Calidad de VidaRESUMEN
BACKGROUND: Understanding the economic value of deucravacitinib and apremilast could assist treatment decision-making for patients with moderate to severe plaque psoriasis. OBJECTIVE: This study compared the cost per response (CPR) for US patients initiating deucravacitinib versus apremilast for moderate to severe plaque psoriasis. METHODS: A CPR model using pharmacy and administration costs was developed from a US payer perspective. Response was defined as a 75% reduction from baseline in Psoriasis Area and Severity Index (PASI 75) at weeks 16 and 24. Long-term response was defined as the cumulative benefit over 52 weeks, measured as area under the curve; subsequent treatment was included. Scenario analyses explored varying the efficacy measure or choices of subsequent treatments and limiting discontinuation. RESULTS: The CPR for deucravacitinib versus apremilast was lower at 16 weeks (difference: -$3796 [95% confidence interval (CI): -$6140 to -$1659]) and 24 weeks (difference: -$12,784 [95% CI: -$16,674 to -$9369]). At 52 weeks, the cost per cumulative benefit was lower for patients who initiated deucravacitinib, regardless of initial treatment period duration (16 or 24 weeks). CONCLUSIONS: Scenario analyses found mainly consistent results. This study showed that the CPR is lower when initiating deucravacitinib versus apremilast in moderate to severe plaque psoriasis.
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Análisis Costo-Beneficio , Psoriasis , Índice de Severidad de la Enfermedad , Talidomida , Humanos , Psoriasis/tratamiento farmacológico , Psoriasis/economía , Estados Unidos , Talidomida/análogos & derivados , Talidomida/economía , Talidomida/uso terapéutico , Productos Biológicos/economía , Productos Biológicos/uso terapéutico , Resultado del Tratamiento , Costos de los Medicamentos , Masculino , FemeninoRESUMEN
Objective: To analyze the epidemiological characteristics and economic burden of palmoplantar pustulosis (PPP) in China. Methods: A population-based retrospective study was conducted using the data from China's Urban Basic Medical Insurance data from January 1, 2012, to December 31, 2016. International Classification of Diseases code and diagnoses in Chinese for PPP were used to identify cases and estimate the prevalence, incidence, and cost. Subgroup analyses were performed according to age and sex, and sensitivity analyses were conducted to evaluate the robustness of the results. Age-adjusted prevalence rates were calculated based on the 2010 national census data. Results: The crude prevalence and incidence rate of PPP in 2016 were 2.730/100 000 (95%CI: 2.218/100 000-3.242/100 000) and 1.556/100 000 (95%CI: 1.154/100 000-1.958/100 000), and the prevalence rate of females (2.910/100 000) was higher than that of males (2.490/100 000, χ2=97.48, P=0.001). The incidence rate of females (1.745/100 000) was also higher than that of males (1.418/100 000, χ2=85.02, P=0.001). The age peak of incidence and prevalence of patients with PPP was in the 30-39-year age group and a small peak existed in the 0-3-year age group among people under 20 years old. From 2012 to 2016, the average number of visits was (2.44±0.04) per patient, and the total per-capita cost per year was (982.40±39.19) yuan. Conclusion: In 2016, the prevalence and incidence rate of PPP in China were higher in females than in males, and the highest age peak was in the 30-39-year age group.
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Psoriasis , Población Urbana , Humanos , China/epidemiología , Psoriasis/epidemiología , Psoriasis/economía , Masculino , Femenino , Estudios Retrospectivos , Prevalencia , Incidencia , Costo de Enfermedad , Persona de Mediana Edad , Adulto , Adolescente , Adulto JovenRESUMEN
Importance: The US lacks a systematic approach for aligning drug prices with clinical benefit, and traditional cost-effectiveness analysis (CEA) faces political obstacles. The efficiency frontier (EF) method offers policymakers an alternative approach. Objective: To assess how the EF approach could align prices and clinical benefits of biologic medications for plaque psoriasis and estimate price reductions in the US vs 4 peer countries: Australia, Canada, France, and Germany. Design and Setting: This health economic evaluation used the EF approach to compare the prices and clinical benefits of 11 biologics and 2 biosimilars for plaque psoriasis in the US, Australia, Canada, France, and Germany. Data were collected from February to March 2023 and analyzed from March to June 2023. Main Outcome Measures: EFs were constructed based on each biologic's efficacy, measured using the Psoriasis Area and Severity Index (PASI) 90 response rate, and annual treatment cost as of January 2023; US costs were net of estimated manufacturer rebates. Prices based on the EF were compared with traditional CEA-based prices calculated by the Institute for Clinical and Economic Review at a threshold of $150â¯000 per quality-adjusted life-year gained. Results: Among 13 biologics, PASI 90 response rates ranged from 17.9% (etanercept) to 71.6% (risankizumab); US net annual treatment costs ranged from $1664 (infliximab-dyyb) to $79â¯277 (risankizumab). The median (IQR) net annual treatment cost was higher in the US ($34â¯965 [$20â¯493-$48â¯942]) than prerebate costs in Australia ($9179 [$6691-$12â¯688]), Canada ($15â¯556 [$13â¯017-$16â¯112]), France ($9478 [$6637-$11â¯678]), and Germany ($13â¯829 [$13â¯231-$15â¯837]). The US EF included infliximab-dyyb (PASI 90: 57.4%; annual cost: $1664), ixekizumab (PASI 90: 70.8%; annual cost: $33â¯004), and risankizumab (PASI 90: 71.6%; annual cost: $79â¯277). US prices for psoriasis biologics would need to be reduced by a median (IQR) of 71% (31%-95%) to align with those estimated using the EF; the same approach would yield smaller price reductions in Canada (41% [6%-57%]), Australia (36% [0%-65%]), France (19% [0%-67%]), and Germany (11% [8%-26%]). Except for risankizumab, the EF-based prices were lower than the prices based on traditional CEA. Conclusions and Relevance: This economic evaluation showed that for plaque psoriasis biologics, using an EF approach to negotiate prices could lead to substantial price reductions and better align prices with clinical benefits. US policymakers might consider using EFs to achieve prices commensurate with comparative clinical benefits, particularly for drug classes with multiple therapeutic alternatives for which differences can be adequately summarized by a single outcome measurement.
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Biosimilares Farmacéuticos , Psoriasis , Humanos , Infliximab/uso terapéutico , Biosimilares Farmacéuticos/uso terapéutico , Etanercept/uso terapéutico , Factores Biológicos/uso terapéutico , Psoriasis/tratamiento farmacológico , Psoriasis/economía , Terapia BiológicaAsunto(s)
Fármacos Dermatológicos , Psoriasis , Psoriasis/tratamiento farmacológico , Psoriasis/economía , Humanos , Fármacos Dermatológicos/uso terapéutico , Fármacos Dermatológicos/economía , Aprobación de Drogas , Desarrollo de Medicamentos/economía , Estados Unidos , Industria Farmacéutica/economíaRESUMEN
BACKGROUND: Proactive management of plaque psoriasis with twice-weekly topical calcipotriol/betamethasone dipropionate (Cal/BD) foam has a demonstrated clinical benefit in preventing disease relapse compared to reactive management, where Cal/BD foam is only given as rescue therapy once-daily for four weeks after relapse. The impact of proactive management with Cal/BD foam on a wider range of clinical responses is not yet known, nor is its potential cost-effectiveness in the healthcare system of Finland. METHODS: This study involved a post-hoc analysis exploring the clinical and patient-reported benefits of proactive versus reactive management with Cal/BD foam observed in the PSO-LONG trial (NCT02899962). A range of response criteria based on modified psoriasis area and severity index (mPASI) and dermatology life quality index (DLQI) were analyzed, and the cost-effectiveness of proactive versus reactive management was estimated in a Finnish healthcare setting. RESULTS AND CONCLUSION: The analysis found a consistent clinical benefit of proactive management compared to reactive management on all response criteria, and a markedly lower cost-per-responder for the response criteria of mPASI 75, mPASI ≤ 2 and DLQ1 ≤ 1. The analysis was robust to sensitivity analyses on key inputs and demonstrates the cost and clinical benefits of proactive over reactive management of plaque psoriasis with Cal/BD foam in the Finnish healthcare setting.
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Betametasona , Calcitriol , Fármacos Dermatológicos , Psoriasis , Aerosoles/uso terapéutico , Betametasona/análogos & derivados , Betametasona/uso terapéutico , Calcitriol/análogos & derivados , Análisis Costo-Beneficio , Fármacos Dermatológicos/uso terapéutico , Combinación de Medicamentos , Finlandia , Humanos , Psoriasis/tratamiento farmacológico , Psoriasis/economía , Recurrencia , Resultado del TratamientoRESUMEN
Plaque psoriasis is a chronic disease requiring long-term therapy. However, long-term real-world treatment patterns and costs are not well characterized. This study examined treatment patterns and healthcare costs among patients newly initiating a biologic or apremilast for moderate-to-severe plaque psoriasis. Included patients had ?1 prescription for secukinumab, ixekizumab, adalimumab, ustekinumab, etanercept, or apremilast between 01/01/2015 and 08/31/2018, no prior use of the index medication, and continuous enrolment 12 months pre-index and 24 months post-index. Treatment adherence, non-persistence, discontinuation, switching, use of combination therapy, and re-initiation were assessed at 12, 18, and 24 -months post-index. In addition, total and psoriasis-related healthcare costs were evaluated at 24 months. A total of 7,773 patients with 24-month follow-up were included. Overall, adherence was low (21.3%-33.5%) and non-persistence was high (58.4%-86.5%) over 24 months. Discontinuation (38.4%-51.3%), switching (29.7%-52.6%), combination therapy (27.6%-42.9%), and re-initiation of the index medication (19.3%-44.5%) were common. Healthcare costs were high and mostly contributed by psoriasis treatment. Therefore, maintaining disease control on long-term therapy is still challenging for many patients.
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Antiinflamatorios no Esteroideos/uso terapéutico , Costos de la Atención en Salud , Psoriasis/tratamiento farmacológico , Psoriasis/economía , Talidomida/análogos & derivados , Adulto , Atención Ambulatoria/economía , Honorarios Farmacéuticos , Femenino , Hospitalización/economía , Humanos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Talidomida/economía , Talidomida/uso terapéuticoRESUMEN
BACKGROUND: Psoriasis is commonly classified as either mild or moderate to severe, without specific parameters to differentiate moderate versus severe disease. This may lead to patients with moderate psoriasis being underrecognized and undertreated. OBJECTIVE: An online survey was conducted to assess Canadian dermatologists’ perspectives on the definition and treatment of psoriasis. METHOD: Dermatologists included in the survey were regional and national leaders with expertise in psoriasis. Questions were developed based on feedback from a steering committee of Canadian dermatologists. RESULTS: Of 88 dermatologists contacted, 69 responded; 42.0% were in practice for >20 years. Most dermatologists reported using the percentage of psoriasis-affected body surface area (BSA) to describe disease severity (90.8% for moderate and 87.5% for severe psoriasis). The lower and upper median cutoffs for moderate psoriasis were reported as 5.0% and 10.0% for BSA and 7.0 and 11.5 for the Dermatology Life Quality Index. Most dermatologists also consider psoriasis location (eg, palms, scalp, genital area, face) as an important indicator of disease severity. The majority of Canadian dermatologists (87.5%) identified access to treatment as one of the biggest challenges for patients with moderate psoriasis. Most dermatologists estimated that ≤40% of their patients with moderate plaque psoriasis were being treated with traditional oral systemics, targeted oral systemics, or biologics. CONCLUSIONS: This is the first survey of Canadian dermatologists on moderate psoriasis. Efforts are needed to implement a clinically useful definition of moderate plaque psoriasis to improve patient care and to raise awareness of the definition among regulatory agencies and reimbursement authorities. J Drugs Dermatol. 2021;20(2):126-132. doi:10.36849/JDD.5531.
Asunto(s)
Dermatólogos/estadística & datos numéricos , Dermatología/normas , Psoriasis/diagnóstico , Índice de Severidad de la Enfermedad , Productos Biológicos/economía , Productos Biológicos/uso terapéutico , Canadá , Dermatología/economía , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Psoriasis/tratamiento farmacológico , Psoriasis/economía , Mecanismo de Reembolso/normas , Encuestas y Cuestionarios/estadística & datos numéricosRESUMEN
OBJECTIVE: Screening psoriasis patients for psoriatic arthritis (PsA) is intended to identify patients at earlier stages of the disease. Early treatment is expected to slow disease progression and delay the need for biologic therapy. Our objective was to determine the cost-effectiveness of screening for PsA in patients with psoriasis in Canada. METHODS: A Markov model was built to estimate the costs and quality-adjusted life years (QALYs) of screening tools for PsA in psoriasis patients. The screening tools included the Toronto Psoriatic Arthritis Screen, Psoriasis Epidemiology Screening Tool, Psoriatic Arthritis Screening and Evaluation, and Early Psoriatic Arthritis Screening Questionnaire (EARP) questionnaires. States of health were defined by disability levels as measured by the Health Assessment Questionnaire. State transitions were modeled based on annual disease progression. Incremental cost-effectiveness ratios and incremental net monetary benefits were estimated. Sensitivity analyses were undertaken to account for parameter uncertainty and to test model assumptions. RESULTS: Screening was cost-effective compared to no screening. The EARP tool had the lowest total cost ($2,000 per patient per year saved compared to no screening) and the highest total QALYs (additional 0.18 per patient compared to no screening). The results were most sensitive to test accuracy and the efficacy of disease-modifying antirheumatic drugs (DMARDs). No screening was cost-effective (at $50,000 per QALY) relative to screening when DMARDs failed to slow disease progression. CONCLUSION: If early therapy with DMARDs delays biologic treatment, implementing screening in patients with psoriasis in Canada is expected to represent a cost savings of $220 million per year and improve the quality of life.
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Artritis Psoriásica/diagnóstico , Artritis Psoriásica/economía , Programas de Detección Diagnóstica/economía , Costos de la Atención en Salud , Psoriasis/diagnóstico , Psoriasis/economía , Encuestas y Cuestionarios/economía , Antirreumáticos/economía , Antirreumáticos/uso terapéutico , Artritis Psoriásica/tratamiento farmacológico , Productos Biológicos/economía , Productos Biológicos/uso terapéutico , Ahorro de Costo , Análisis Costo-Beneficio , Evaluación de la Discapacidad , Costos de los Medicamentos , Diagnóstico Precoz , Femenino , Humanos , Masculino , Cadenas de Markov , Persona de Mediana Edad , Modelos Económicos , Valor Predictivo de las Pruebas , Psoriasis/tratamiento farmacológico , Calidad de Vida , Años de Vida Ajustados por Calidad de VidaRESUMEN
OBJECTIVES: To compare treatment patterns and costs among psoriasis patients with and without metabolic conditions newly initiating a biologic or apremilast. METHODS: Adult patients included had ≥1 prescription for secukinumab, adalimumab, ustekinumab, etanercept, or apremilast between 01/01/2015 and 08/31/2018 (date of first prescription was index date) and no index drug use in the 12-months pre-index, and continuous enrollment in the 12-month pre-index and 24-month post-index periods. Patients were divided into mutually exclusive treatment cohorts and stratified by their pre-index metabolic condition status. Treatment patterns (adherence, non-persistence, switching, discontinuation, use of combination therapy, and re-initiation) and healthcare costs were compared. RESULTS: Overall, 7773 patients were included; 47.5-56.7% had a metabolic condition. Except for the apremilast group, patients with metabolic conditions had higher discontinuation (secukinumab: 50.6% vs. 43.7%; adalimumab*: 53.9% vs. 48.7%; ustekinumab*: 41.9% vs. 35.1%; etanercept: 42.8% vs. 41.2%; apremilast: 43.1% vs. 46.1%) and switching (secukinumab: 48.1% vs. 41.2%; adalimumab*: 47.8% vs. 41.9%; ustekinumab*: 34.5% vs. 25.3%; etanercept*: 53.6% vs. 51.5%; apremilast: 45.8% vs. 44.6%) than patients without (*p < .05). Patients with metabolic conditions incurred significantly higher costs. CONCLUSION: Many psoriasis patients initiating biologics or apremilast had metabolic conditions. These patients had higher discontinuation and switching, and significantly higher healthcare costs.
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Fármacos Dermatológicos/uso terapéutico , Costos de la Atención en Salud/estadística & datos numéricos , Psoriasis/tratamiento farmacológico , Adalimumab/economía , Adalimumab/uso terapéutico , Adulto , Bases de Datos Factuales , Fármacos Dermatológicos/economía , Etanercept/economía , Etanercept/uso terapéutico , Femenino , Humanos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Psoriasis/economía , Estudios Retrospectivos , Talidomida/análogos & derivados , Talidomida/economía , Talidomida/uso terapéutico , Resultado del Tratamiento , Ustekinumab/economía , Ustekinumab/uso terapéuticoRESUMEN
BACKGROUND: Psoriasis is a chronic and stigmatising disease with significant and hard to meet clinical needs in patient management. Psoriasis is a relatively common disease, affecting up to 2% of the population. The impact of psoriasis on quality of life is significant given its chronicity and visibility. Psychological stress is a well-established systemic triggering factor in psoriasis. It has been associated with initial presentation of the disease as well as exacerbations of pre-existing psoriasis. The purpose of this study is to assess the psychological, social and financial implications of psoriasis. SUBJECTS AND METHODS: 51 patients participated in this study. After dermatological examination and determination of Psoriasis Area and Severity Index score, patients were referred to a psychological consult. Assessment was done through questionnaires concerning quality of life, depression, anxiety, illness perception, financial domain and personal data. RESULTS: Results of our study indicate that psoriasis has a strong impact on patients' life. It influences working habits, poses a significant financial burden, but most of all, significantly impairs their quality of life and psychological status. CONCLUSION: Psoriasis poses a substantial threat to several dimensions in patient's quality of life. Patients feel that the current treatment, although often effective, does not provide a satisfactory long-term solution. Thus, long-term psychologic support for patients with psoriasis is desirable.
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Psoriasis/economía , Psoriasis/psicología , Calidad de Vida , Estrés Psicológico , Adolescente , Adulto , Anciano , Ansiedad/complicaciones , Depresión/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psoriasis/complicaciones , Psoriasis/terapia , Índice de Severidad de la Enfermedad , Estrés Psicológico/complicaciones , Estrés Psicológico/terapia , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Clinical and economic comparisons of therapies for plaque psoriasis are regularly updated following each new devel- opment in the field. With the recent availability of a novel accessory (Multi Micro DoseTM [MMD®] tip) for the 308nm excimer laser (XTRAC®, Strata Skin Sciences, Horsham, PA), which can determine and deliver an optimal therapeutic dose (OTDTM) of ultraviolet-B light in an improved protocol, the need for comparative health-economic assessment recurs. To this end, a comprehensive evaluation of treatment-related costs was undertaken from the payer perspective. Results show that outcomes are influenced by many factors; most importantly, the severity and extent of disease, treatment selection, and patient preference, as well as compliance, adherence, and persistence with care. Among study comparators, the 308nm excimer laser – XTRAC – with its latest MMD enhancement, is safe and delivers incremental clinical benefits with the potential for significant cost savings. These benefits are particularly relevant today in the context of SARS-CoV-2 virus and the COVid-19 pandemic. J Drugs Dermatol. 2020;19(11):1101-1108. doi:10.36849/JDD.2020.5510.
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Infecciones por Coronavirus , Costos de la Atención en Salud/estadística & datos numéricos , Pandemias , Neumonía Viral , Psoriasis/terapia , COVID-19 , Análisis Costo-Beneficio , Humanos , Láseres de Excímeros/uso terapéutico , Cooperación del Paciente , Prioridad del Paciente , Psoriasis/economía , Psoriasis/patología , Índice de Severidad de la Enfermedad , Terapia Ultravioleta/economía , Terapia Ultravioleta/métodosRESUMEN
BACKGROUND: Skin conditions are photoresponsive if they respond to ultraviolet (UV) radiation with partial or complete clearing. Ultraviolet phototherapy is performed by exposing the skin to UV radiation on a regular basis under medical supervision. Three types of UV radiation are used to treat photoresponsive skin conditions: broadband ultraviolet B (BB-UVB), psoralen plus ultraviolet A (PUVA), and narrowband ultraviolet B (NB-UVB). Narrowband UVB phototherapy is generally more effective than BB-UVB and safer than PUVA in the management of several photoresponsive skin conditions. While typically performed in an outpatient clinic setting, home NB-UVB phototherapy may be a viable option for people with limited access to outpatient treatment. We conducted a health technology assessment of home NB-UVB phototherapy for people with photoresponsive skin conditions that included an evaluation of the effectiveness, safety, cost-effectiveness, and budget impact of publicly funding home NB-UVB phototherapy, and patient preferences and values. METHODS: We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using version 2 of the Cochrane risk-of-bias tool for randomized studies, and we assessed the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search and conducted a cost-utility analysis with a 10-year horizon from a public payer perspective. The cost-utility analysis was conducted for psoriasis based on the available clinical evidence. We also analyzed the budget impact of publicly funding home NB-UVB phototherapy in people with photoresponsive skin conditions in Ontario. To contextualize the potential value of NB-UVB phototherapy, we spoke with people with photoresponsive skin conditions. RESULTS: We included one randomized controlled trial in the clinical evidence review. We found that home NB-UVB phototherapy is at least as effective as outpatient clinic NB-UVB phototherapy for the treatment of mild to severe psoriasis (the only photoresponsive skin condition investigated in the included study). In the included study, 82% of participants were treated at home, compared with 79% treated in an outpatient clinic setting (many participants had experience with both treatment settings). They demonstrated an improvement in baseline Psoriasis Area and Severity Index 50 (mean difference 2.8%, 95% confidence interval -8.6% to 14.2%), with the mean difference exceeding the preset noninferiority margin of -15%. Similar results were observed for other psoriasis area and severity indices (GRADE: Moderate). Episodes of mild erythema, burning sensation, severe erythema, and blistering were reported in both treatment groups, but were too few to allow a comparative safety assessment (GRADE: Low).The primary economic evaluation showed that home NB-UVB phototherapy is more costly (incremental cost $4,509) and has higher quality-adjusted life-years (QALYs; incremental QALY 0.29) than outpatient clinic NB-UVB. Our best estimate of the incremental cost-effectiveness ratio of home NB-UVB compared with outpatient clinic NB-UVB is $15,675 per QALY gained. The probability of home NB-UVB being cost-effective versus outpatient clinic NB-UVB is 77% at a willingness-to-pay of $50,000 per QALY gained. Publicly funding home NB-UVB phototherapy in the psoriasis population would lead to about $0.7 million each year and a total 5-year net budget impact of about $3.3 million. Publicly funding home treatment for people with photoresponsive skin conditions would lead to about $1.3 million each year and a total 5-year net budget impact of $6.3 million; however, this scenario accounted for the cost of phototherapy only (it did not include treatment-specific medical costs for conditions other than psoriasis).People with photoresponsive skin conditions with whom we spoke viewed home NB-UVB phototherapy as beneficial for those with health conditions that make it difficult to travel, for those with busy schedules, and for those who may not have the means to pay for travel to clinics. CONCLUSIONS: Home NB-UVB phototherapy is at least as effective as outpatient clinic NB-UVB phototherapy for the treatment of mild to severe psoriasis (GRADE: Moderate). We are uncertain if adverse events happen more often or less often with home NB-UVB phototherapy than outpatient clinic NB-UVB phototherapy (GRADE: Low).Home NB-UVB phototherapy has an ICER of $15,675 per QALY gained, and the probability of home NB-UVB phototherapy being cost-effective is 77% at a willingness-to-pay of $50,000 per QALY gained. When accounting for the cost of phototherapy and other psoriasis-specific treatment costs (e.g., physician visits and adjuvant treatments), publicly funding home NB-UVB phototherapy in the psoriasis population would lead to a total 5-year net budget impact of about $3.3 million. Funding home NB-UVB phototherapy to people with photoresponsive skin conditions would lead to a total 5-year net budget impact of $6.3 million.People with photoresponsive skin conditions with whom we spoke viewed both outpatient clinic and home NB-UVB phototherapy to be effective treatment options.
Asunto(s)
Análisis Costo-Beneficio , Servicios de Atención de Salud a Domicilio , Psoriasis/terapia , Calidad de Vida , Terapia Ultravioleta/métodos , Costos de la Atención en Salud , Servicios de Atención de Salud a Domicilio/economía , Humanos , Satisfacción del Paciente , Psoriasis/economía , Psoriasis/patología , Años de Vida Ajustados por Calidad de Vida , Índice de Severidad de la Enfermedad , Piel/patología , Piel/efectos de la radiación , Evaluación de la Tecnología Biomédica , Terapia Ultravioleta/economíaRESUMEN
BACKGROUND: Rheumatoid arthritis (RA), psoriatic arthritis (PsA), and psoriasis (PSO) are immune-mediated systemic, chronic inflammatory conditions. Moderate to severe disease is treated with conventional disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, or leflunomide. If a patient does not respond to these firstline treatments, then tumor necrosis factor inhibitor (TNFi) or non-TNFi immunotherapy agents are administered via infusion, injection, or taken orally. Although the effectiveness of established infusion, injection, and newer oral therapies are known, the relative effectiveness among the routes of administration is not well understood. OBJECTIVE: To compare drug use, health care resource utilization, and costs among patients who are treatment-naive to oral immunotherapy and injectable biologic immunotherapy. METHODS: This retrospective observational study used claims data from a large U.S. health plan to identify new users of oral and injectable immunotherapy, diagnosed with a joint (RA or PsA), skin (PSO), or joint and skin condition from July 1, 2014, to June 30, 2017. The index date was the first claim for an oral or injectable medication. Medicaid, Medicare Advantage, and commercial plan patients aged 19-89 years with continuous enrollment 6 months before and 12 months after the index date were included in the study. Outcomes were adjusted using propensity score by inverse probability of treatment weighting. Treatment discontinuation, switching, health care resource utilization, and costs were measured during the post-index period. RESULTS: Oral versus injectable users with joint (n = 458 vs. 3,875), skin (n = 265 vs. 951), or joint and skin (n = 171 vs. 805) conditions were identified. For drug utilization outcomes, no differences in discontinuation rates were observed between oral and injectable groups for any of the cohorts. However, those in skin and joint and skin cohorts had higher rates of switching to other immunotherapies in patients initiated on orals compared with injectables. Health care resource utilization outcomes were mixed. While mean outpatient and physician office visits were significantly higher in oral compared with injectable groups across all 3 cohorts, no differences were observed for inpatient stays. Total costs (medical plus pharmacy) were lower for oral groups across all 3 cohorts. Pharmacy costs were lower for oral groups, but medical costs were higher for oral groups across all 3 cohorts. CONCLUSIONS: This is the first population-level study at a route-of-administration level, which compared switching, health care resource utilization, and costs across several conditions. Switching drugs was more likely in the oral group, which may indicate lower effectiveness or tolerability of oral immunotherapies relative to injectables. Health care resource utilization was higher in the oral group, but total costs were lower, which was likely driven by the lower costs of oral drugs. DISCLOSURES: This study was a Humana internal study, and all authors were at the time employees of Humana and used Humana resources. The authors have no conflicts of interest or financial interests to disclose that relate to the research described in this study. This study was presented as a podium and poster presentation at the AMCP Managed Care & Specialty Pharmacy Annual Meeting; April 23-26, 2018; Boston, MA.
Asunto(s)
Artritis Psoriásica/tratamiento farmacológico , Artritis Reumatoide/tratamiento farmacológico , Inmunoterapia/métodos , Psoriasis/tratamiento farmacológico , Administración Oral , Antirreumáticos/administración & dosificación , Antirreumáticos/economía , Artritis Psoriásica/economía , Artritis Psoriásica/inmunología , Artritis Reumatoide/economía , Artritis Reumatoide/inmunología , Productos Biológicos/administración & dosificación , Productos Biológicos/economía , Enfermedad Crónica , Estudios de Cohortes , Femenino , Humanos , Inmunoterapia/economía , Inyecciones , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Psoriasis/economía , Psoriasis/inmunología , Estudios RetrospectivosRESUMEN
Calcipotriene 0.005% plus betamethasone dipropionate 0.064% (Cal/BD) aerosol foam is a topical agent indicated for the treatment of plaque psoriasis. While topical treatments are typically reserved for milder disease, in clinical trials with Cal/BD foam, the vast majority of patients had beyond-mild psoriasis at baseline, and multiple studies (including subgroup analyses from randomized controlled trials and other small-scale studies) have demonstrated favorable outcomes with the use of Cal/BD foam in this population. The objective of this article is to review existing data on the efficacy, safety, and cost-effectiveness of Cal/BD foam used in patients with beyond-mild psoriasis, either alone as topical monotherapy or as adjunctive therapy. Practical recommendations for managing beyond-mild psoriasis with Cal/BD foam are also provided. J Drugs Dermatol. 2020;19(8): doi:10.36849/JDD.2020.5300.
Asunto(s)
Betametasona/análogos & derivados , Productos Biológicos/administración & dosificación , Calcitriol/análogos & derivados , Fármacos Dermatológicos/administración & dosificación , Psoriasis/tratamiento farmacológico , Administración Cutánea , Aerosoles , Betametasona/administración & dosificación , Betametasona/efectos adversos , Betametasona/economía , Productos Biológicos/efectos adversos , Productos Biológicos/economía , Calcitriol/administración & dosificación , Calcitriol/efectos adversos , Calcitriol/economía , Análisis Costo-Beneficio , Fármacos Dermatológicos/efectos adversos , Fármacos Dermatológicos/economía , Combinación de Medicamentos , Quimioterapia Combinada/efectos adversos , Quimioterapia Combinada/economía , Quimioterapia Combinada/métodos , Humanos , Psoriasis/diagnóstico , Psoriasis/economía , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Talidomida/administración & dosificación , Talidomida/efectos adversos , Talidomida/análogos & derivados , Talidomida/economía , Resultado del TratamientoAsunto(s)
Productos Biológicos/economía , Fármacos Dermatológicos/economía , Costos de los Medicamentos/tendencias , Industria Farmacéutica/tendencias , Gastos en Salud/tendencias , Psoriasis/tratamiento farmacológico , Productos Biológicos/administración & dosificación , Costo de Enfermedad , Fármacos Dermatológicos/administración & dosificación , Costos de los Medicamentos/estadística & datos numéricos , Industria Farmacéutica/economía , Industria Farmacéutica/estadística & datos numéricos , Apoyo Financiero , Gastos en Salud/estadística & datos numéricos , Humanos , Psoriasis/economía , Autoadministración/economía , Autoadministración/estadística & datos numéricos , Estados UnidosRESUMEN
OBJECTIVES: To assess productivity loss (PL) variations across a set of chronic diseases and analyze significant PL drivers (demographics, health status, healthcare resource use) in Hungary. METHODS: Data from 11 cost-of-illness studies (psoriasis, dementia, systemic sclerosis, multiple sclerosis, benign prostatic hyperplasia, Parkinson's disease, psoriatic arthritis, rheumatoid arthritis, schizophrenia, epilepsy, and diabetes) were pooled, and patient-level data were analyzed. A weighted multiple linear regression analysis was run to identify significant PL indicators. All costs were adjusted to 2018 euro rates and PL was further presented as a proportion of gross domestic product/capita, facilitating results comparability and transferability. RESULTS: The dataset comprised 1888 patients from 11 chronic diseases. The average indirect cost/(gross domestic product/capita) ratio was highest in schizophrenia (72.4%) and rheumatoid arthritis (71.3%) and lowest in benign prostatic hyperplasia (1.6%). Correlation results infer that a higher EuroQol 5-dimension 3-level index score was significantly associated with lower PL. The number of hospital admissions was the main contributor toward increasing PL among resource use indicators. Age and sex showed inconsistent and insignificant correlations with PL. In regression analysis, a better EuroQol 5-dimension 3-level index score and higher education were consistently associated with decreasing PL in all models. CONCLUSIONS: This article will enable health decision makers to understand the importance of adopting a societal perspective for chronic disease reimbursement decisions. The correlation between PL and health status supports that timely started effective treatments may prevent patients from losing their workability.
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Enfermedad Crónica/economía , Costo de Enfermedad , Eficiencia , Artritis Psoriásica/economía , Artritis Psoriásica/epidemiología , Artritis Psoriásica/terapia , Artritis Reumatoide/economía , Artritis Reumatoide/epidemiología , Artritis Reumatoide/terapia , Enfermedad Crónica/terapia , Análisis Costo-Beneficio/métodos , Demencia/economía , Demencia/epidemiología , Demencia/terapia , Humanos , Hungría , Modelos Lineales , Masculino , Enfermedad de Parkinson/economía , Enfermedad de Parkinson/epidemiología , Enfermedad de Parkinson/terapia , Hiperplasia Prostática/economía , Hiperplasia Prostática/epidemiología , Hiperplasia Prostática/terapia , Psoriasis/economía , Psoriasis/epidemiología , Psoriasis/terapia , Esquizofrenia/economía , Esquizofrenia/epidemiología , Esquizofrenia/terapia , Esclerodermia Sistémica/economía , Esclerodermia Sistémica/epidemiología , Esclerodermia Sistémica/terapia , Encuestas y CuestionariosRESUMEN
BACKGROUND: In Québec, targeted biologic therapies for moderate to severe plaque psoriasis are restricted to patients who have not responded to phototherapy or conventional systemic treatment, primarily due to high drug costs. Apremilast, an oral treatment for plaque psoriasis, was added to the Québec provincial health insurance plan (Régie de l'assurance maladie du Québec; RAMQ) formulary in 2015, making this the only province in Canada with public drug plan reimbursement for apremilast. OBJECTIVES: The aim of this study is to describe patients' characteristics, treatment patterns, healthcare resource utilization (HCRU), and associated costs and to measure real-world budget impact of using apremilast before biologics in plaque psoriasis. METHODS: This study was performed using RAMQ drug claims and medical services data. Patients diagnosed with psoriasis between January 2015 and December 2017 were identified. Medical services and prescription claims were categorized as all-cause and psoriasis-related. Using RAMQ database estimates, a 3-year budget impact analysis was developed comparing treatment cost with and without the addition of apremilast to the formulary. RESULTS: In all, 540 patients were identified (apremilast: n = 92; biologics: n = 448). Comorbidity burden and treatment persistence and adherence were comparable between apremilast and biologic users. The year following the index date, all-cause HCRU was lower for apremilast versus biologic users (CAN$19 763 vs CAN$28 025; P < .01), mainly driven by drug cost. Using apremilast before biologics resulted in an estimated RAMQ net savings of CAN$49 290 (2015), CAN$746 856 (2016), and CAN$1 216 512 (2017), and a total savings of CAN$2 012 658 since apremilast's addition to the formulary. CONCLUSION: Adding apremilast to the drug formulary of other Canadian provinces could result in significant healthcare savings.