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      Biologicals and small molecules in psoriasis: A systematic review of economic evaluations

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          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.

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          Psoriasis and comorbid diseases: Epidemiology.

          Psoriasis is a common chronic inflammatory disease of the skin that is increasingly being recognized as a systemic inflammatory disorder. Psoriatic arthritis is a well-known comorbidity of psoriasis. A rapidly expanding body of literature in various populations and settings supports additional associations between psoriasis and cardiometabolic diseases, gastrointestinal diseases, kidney disease, malignancy, infection, and mood disorders. The pathogenesis of comorbid disease in patients with psoriasis remains unknown; however, shared inflammatory pathways, cellular mediators, genetic susceptibility, and common risk factors are hypothesized to be contributing elements. As additional psoriasis comorbidities continue to emerge, education of health care providers is essential to ensuring comprehensive medical care for patients with psoriasis.
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            Translating the science of quality of life into practice: What do dermatology life quality index scores mean?

            This study's aim was to determine the relationship between Dermatology Life Quality Index (DLQI) scores and a Global Question (GQ) concerning patients' views of the overall impairment of their skin-related quality of life (QoL), and to express this relationship by identifying bands of DLQI scores equivalent to each GQ descriptor. A DLQI questionnaire and the GQ were mailed to 3834 adult general dermatology outpatients. There were 1993 (52%) responses: male 841; female 1152. Mean DLQI score = 4.86 (range 0-30, standard deviation (SD) = 5.83). Mean GQ score = 1.22 (range 0-4, SD = 1.20). The mean, mode, and median of the GQ scores for each DLQI score were used to devise several sets of bands of DLQI scores, and kappa coefficients of agreement calculated. The set proposed for adoption is: DLQI scores 0-1 = no effect on patient's life (GQ = 0, n = 754); DLQI scores 2-5 = small effect on patient's life (GQ = 1, n = 611); DLQI scores 6-10 = moderate effect on patient's life (GQ = 2, n = 327); DLQI scores 11-20 = very large effect on patient's life (GQ = 3, n = 242); DLQI scores 21-30 = extremely large effect on patient's life (GQ = 4, n = 59); kappa coefficient 0.489. Banding of the DLQI will aid the clinical interpretation of an individual's DLQI score and allow DLQI scores to inform clinical decisions.
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              Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria.

              The aim of the Consensus on Health Economic Criteria (CHEC) project is to develop a criteria list for assessment of the methodological quality of economic evaluations in systematic reviews. The criteria list resulting from this CHEC project should be regarded as a minimum standard. The criteria list has been developed using a Delphi method. Three Delphi rounds were needed to reach consensus. Twenty-three international experts participated in the Delphi panel. The Delphi panel achieved consensus over a generic core set of items for the quality assessment of economic evaluations. Each item of the CHEC-list was formulated as a question that can be answered by yes or no. To standardize the interpretation of the list and facilitate its use, the project team also provided an operationalization of the criteria list items. There was consensus among a group of international experts regarding a core set of items that can be used to assess the quality of economic evaluations in systematic reviews. Using this checklist will make future systematic reviews of economic evaluations more transparent, informative, and comparable. Consequently, researchers and policy-makers might use these systematic reviews more easily. The CHEC-list can be downloaded freely from http://www.beoz.unimaas.nl/chec/.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                3 January 2018
                2018
                : 13
                : 1
                : e0189765
                Affiliations
                [1 ] Department of Dermatology, University Medical Center Göttingen, Göttingen University, Göttingen, Germany
                [2 ] Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
                [3 ] Faculty of Economic Sciences, Göttingen University, Göttingen, Germany
                [4 ] Department of Health Science, University of York, Heslington, York, United Kingdom
                [5 ] Department of Dermatology and Phlebology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
                Kinki Daigaku, JAPAN
                Author notes

                Competing Interests: Dr. Kromer obtained honoraria from Janssen-Cilag. Prof. Ludwig-Peitsch served as investigator for Abbvie, Boehringer-Ingelheim, Eli Lilly, Janssen-Cilag, Merck, Novartis, Pfizer and UCB Pharma; was member of an advisory board of Abbvie, Eli Lilly, LEO Pharma, MSD and Novartis; obtained honoraria from ALK-Abello, Abbvie, Janssen-Cilag, MSD, Novartis and Roche; and received support for conferences from Abbvie, Actelion, ALK-Abello, Allergika, Alma Lasers, ARC Lasers, Asclepion, Beiersdorf, BMS, Celgene, Dermapharm, Dermasence, Eli Lilly, Galderma, GSK, IGEA, Interlac, Janssen-Cilag, L’Oreal, La Roche Posay, LEO Pharma, Medac, Merck, MSD, Novartis, Pierre Fabre, P&M Cosmetics, Pfizer, Roche and Stiefel. Mr. Celis and Dr. Sonntag have no conflict of interest to declare. The review presented here was not supported by pharmaceutical companies. The competing interests do not alter our adherence to PLOS ONE policies on sharing data and materials.

                ‡ These authors share senior authorship on this work.

                Author information
                http://orcid.org/0000-0003-2478-2951
                Article
                PONE-D-17-04225
                10.1371/journal.pone.0189765
                5751984
                29298315
                a732b830-5ff1-4dea-ada5-cc5e8c56b1e7
                © 2018 Kromer et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 9 February 2017
                : 24 November 2017
                Page count
                Figures: 4, Tables: 5, Pages: 22
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Social Sciences
                Economics
                Economic Analysis
                Cost-Effectiveness Analysis
                Medicine and Health Sciences
                Clinical Medicine
                Clinical Immunology
                Autoimmune Diseases
                Psoriasis
                Biology and Life Sciences
                Immunology
                Clinical Immunology
                Autoimmune Diseases
                Psoriasis
                Medicine and Health Sciences
                Immunology
                Clinical Immunology
                Autoimmune Diseases
                Psoriasis
                Social Sciences
                Economics
                Engineering and Technology
                Electronics
                Comparators
                Research and Analysis Methods
                Research Assessment
                Systematic Reviews
                Social Sciences
                Economics
                Health Economics
                Medicine and Health Sciences
                Health Care
                Health Economics
                Research and Analysis Methods
                Research Design
                Clinical Research Design
                Adverse Events
                Research and Analysis Methods
                Database and Informatics Methods
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                All relevant data are within the paper and its Supporting Information files.

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