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Cost-effectiveness of systemic treatments for moderate-to-severe psoriasis in the German health care setting.

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      Abstract

      Systemic treatments of moderate-to-severe psoriasis differ substantially in terms of effectiveness and costs. Comprehensive economic-evaluations of all systemic treatments for psoriasis from a societal perspective are missing. The objective of our study was to compare the cost-effectiveness all systemic treatments approved for moderate-to-severe psoriasis from a societal perspective, by including all cost categories. An incremental cost-effectiveness-analysis was performed for all systemic treatments for psoriasis, currently recommended by the German S3-Guideline i.e. methotrexate, cyclosporine, fumaric acid esters, and retinoids, adalimumab, etanercept, infliximab and ustekinumab. We used a Markov model with time-dependent transition probabilities and a time horizon of 2 years to investigate incremental cost-effectiveness ratios. Both direct and indirect costs were considered to reflect the societal perspective. Effectiveness outcome was PASI-75 response. One-way and probabilistic sensitivity analyses explored the effect of treatment duration, discount rate, effectiveness, and the perspective (societal vs. healthcare system) on the findings. According to the base-case analysis a cost-effective treatment pathway for moderate-to-severe psoriasis starts with methotrexate, followed by ustekinumab 90 mg and infliximab, if methotrexate does not achieve or maintain PASI-75 response. Sensitivity analyses confirmed the general robustness of these findings with methotrexate being most cost-effective. However, from a third-party-payer perspective (without indirect cost) conventional therapies were generally more cost-effective than biologics. From a value-based healthcare perspective, methotrexate should be the systemic treatment of first choice, ustekinumab 90 mg second choice and infliximab third choice for patients with moderate-to-severe psoriasis. From a societal perspective, the other treatments are less efficient according to our model. From a third-party-payer perspective conventional therapies are more cost-effective than biologics.

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      Affiliations
      [1 ] Centre for Evidence-based Healthcare, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. denise.kuester@uniklinikum-dresden.de.
      [2 ] Division of Evidence Based Medicine (DEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité, Universitätsmedizin Berlin, Berlin, Germany.
      [3 ] Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
      [4 ] Department of Dermatology, Venereology, and Allergology, J.W. Goethe-University Hospital, Frankfurt, Germany.
      [5 ] Evidence-based Medicine Frankfurt, Institute for General Practice, Goethe University, Frankfurt, Germany.
      [6 ] Department of Dermatology, University Hospital Carl Gustav Carus, Dresden, Germany.
      [7 ] Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
      [8 ] Centre for Evidence-based Healthcare, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
      Journal
      Arch. Dermatol. Res.
      Archives of dermatological research
      Springer Nature
      1432-069X
      0340-3696
      May 2016
      : 308
      : 4
      26961372
      10.1007/s00403-016-1634-y
      10.1007/s00403-016-1634-y

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