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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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      Most cited references 79

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      Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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        Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party.

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          Psoriasis--epidemiology and clinical spectrum.

          Despite psoriasis being a common skin disease, there are still a number of unanswered questions. One of these is the prevalence of the disease, as there is a lack of specific data, with the majority of studies reporting estimates only. Population based studies are rare and longitudinal observations on changing prevalence rates are lacking. This contrasts with other T-cell mediated autoimmune diseases where the number of those affected is rising. Epidemiological studies revealed that a distinct group of diseases is quite frequently associated with psoriasis, e.g. arthritis, colitis, diabetes and hypertension. In contrast, atopic dermatitis and allergies are less frequently seen compared to normal rates of occurrence. As the psoriatic immune response pattern relates to activated Th-1 cells, psoriasis and atopic dermatitis appear to be mutually exclusive due to the Th-1/Th-2 dichotomy.
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            Author and article information

            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.

            Contributors
            Role: Conceptualization, Role: Data curation, Role: Formal analysis, Role: Investigation, Role: Methodology, Role: Software, Role: Validation, Role: Visualization, Role: Writing – original draft
            Role: Data curation, Role: Formal analysis, Role: Investigation, Role: Methodology, Role: Validation, Role: Writing – review & editing
            Role: Conceptualization, Role: Investigation, Role: Methodology, Role: Project administration, Role: Resources, Role: Software, Role: Supervision, Role: Writing – review & editing
            ORCID: http://orcid.org/0000-0003-2478-2951, Role: Conceptualization, Role: Investigation, Role: Methodology, Role: Project administration, Role: Resources, Role: Supervision, Role: 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
            29298315
            5751984
            10.1371/journal.pone.0189765
            PONE-D-17-04225
            (Editor)
            © 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.

            Counts
            Figures: 4, Tables: 5, Pages: 22
            Product
            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
            Database Searching
            Custom metadata
            All relevant data are within the paper and its Supporting Information files.

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