A pharmacoeconomic analysis of topical therapies for patients with mild-to-moderate stable plaque psoriasis: a US study.

Psoriasis is a persistent skin disorder characterized by abnormal keratinocyte differentiation, keratinocyte hyperproliferation, and increased expression of inflammatory markers at the cellular level, leading to erythema, induration, and scaling of the skin. Depending on the severity of the disease, annual outpatient costs range from $1400 to $6600 per patient, totaling $3.2 billion each year in the United States. Because the disease is persistent and progressive, patients receiving a diagnosis of psoriasis early in life can expect to require lifelong care, which translates into lifelong expense. Treatments include topical formulations, systemic therapies, phototherapies, and combination therapies. Of these, topical agents are the first-line treatments, including fluocinonide and other steroids, calcipotriene, and tazarotene, a once-daily retinoid. To establish the relative cost-effectiveness of these drugs (fluocinonide, calcipotriene, and tazarotene), we conducted a pharmacoeconomic study from the perspective of a third-party payer, using a decision-analytic model validated by clinical experts. Data were drawn from a meta-analysis of the contemporary medical literature. Clinical success, clearing, and relapse rates determined the probabilities for therapeutic outcomes and the number of anticipated disease-free days for each study comparator. Costs for physician visits, drug acquisition, laboratory testing, and adverse-events management were added to each branch of the decision tree and multiplied by the appropriate probabilities to establish the expected cost of treatment, stratified by the primary treatment choice. Cost-effectiveness was expressed as the total expected cost of achieving a disease-free day. Tazarotene 0.1% was 16.74% more cost-effective than tazarotene 0.05%, 85.46% more cost-effective than fluocinonide, and 143.75% more cost-effective than calcipotriene. The expected cost of achieving a disease-free day was $49.46 for tazarotene 0.1%, $57.74 for tazarotene 0.05%, $91.73 for fluocinonide, and $120.56 for calcipotriene. Treatment with tazarotene offers an opportunity to reduce the cost of care for patients with mild-to-moderate psoriasis and enhance patient satisfaction by gaining more disease-free days.

A pharmacoeconomic evaluation of staging modalities for patients with newly diagnosed and occult recurrent adenocarcinoma of the prostate.

Costs of staging prostate cancer using the Kit for the Preparation of Indium In111 capromab pendetide, a radiolabeled monoclonal antibody directed against prostate-specific membrane antigen, were evaluated using a medical decision model. Subjects were patients with newly diagnosed adenocarcinoma at risk for metastatic disease based on prostate specific antigen screening ≥10 and Gleason score ≥7, and occult recurrent disease. Information for the model was obtained from a meta-analysis of data from published medical literature, clinical trials, databases analysis, and expert opinion provided by an expert panel of five specialists in urology, surgery, radiation oncology, and nuclear medicine. When capromab pendetide, computed tomography, magnetic resonance imaging, and pelvic lymph node dissection were compared in patient with newly diagnosed or occult recurrent disease, capromab pendetide produced cost savings due to its ability to identify soft tissue lesions consistent with prostate cancer and to help establish the extent of disease.

Pricing specialty carve-outs and disease management programs under managed care.

The drive toward improved efficiency and effectiveness in health care has spawned disease management programs to address the needs of patients with certain conditions. These programs parallel traditional case management programs in monitoring patients, but disease management differs from case management in early assessment of patient risk, with proactive clinical interventions and educational efforts. The most comprehensive programs include a coordinated delivery system that can be "carved out" from other health care benefits. Pricing disease management can benefit from the analysis of detailed, disease-specific and community-specific data from public or private sources.