Original article
Estimated cost efficacy of systemic treatments that are approved by the US Food and Drug Administration for the treatment of moderate to severe psoriasis

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Background

Newer psoriasis treatments tout higher efficacy but are generally more expensive.

Objective

We sought to estimate the cost efficacy of systemic psoriasis treatments that have been approved by the US Food and Drug Administration (FDA).

Methods

A literature review of systemic psoriasis treatments that have been approved by the FDA was performed for the primary end point of a 75% reduction in the Psoriasis Area and Severity Index score (PASI 75). Medication cost was referenced by wholesale acquisition cost (WAC), laboratory fees were obtained from the American Medical Association, and office visit fees are standard at our university. Total expenses were standardized by calculating cost per month of treatment considering the number needed to treat (NNT) to achieve PASI 75.

Results

Methotrexate ($794.05-1502.51) and cyclosporine ($1410.14-1843.55) had the lowest monthly costs per NNT to achieve PASI 75. The most costly therapies were infliximab ($8704.68-15,235.52) and ustekinumab 90 mg ($12,505.26-14,256.75). Monthly costs per NNT to achieve PASI 75 for other therapies were as follows: narrowband ultraviolet B light phototherapy ($2924.73), adalimumab ($3974.61-7678.78), acitretin ($4137.71-14,148.53), ustekinumab 45 mg ($7177.89-7263.99), psoralen plus ultraviolet A light phototherapy ($7499.46-8834.98), and etanercept ($8284.71-10,674.89).

Limitations

Drug rebates and incentives, potential adverse effects, comorbidity risk reduction, ambassador programs, and combination therapies were excluded.

Conclusion

Our study provides meaningful cost efficacy data that may influence psoriasis treatment selection.

Section snippets

Methods

A literature review of PubMed was performed regarding the efficacy of all systemic medications that are currently approved by the FDA for the treatment of psoriasis (ie, narrowband ultraviolet B light phototherapy [NBUVB], psoralen plus ultraviolet A light phototherapy [PUVA], acitretin, methotrexate, cyclosporine, etanercept, adalimumab, infliximab, and ustekinumab) with the search terms “psoriasis” and “PASI 75” published between 1991 and 2013. Preference for inclusion was given to randomized

Results

Twenty-six studies encompassing 39 treatment regimens (7099 patients) met our search criteria (Table I). The medication, office visit, and laboratory costs per treatment period for each of the 39 studies are shown in Table II. Methotrexate, cyclosporine, and acitretin generally require more frequent office visits than phototherapy and biologic medications. While baseline laboratory costs are generally similar across all the medications except for phototherapy, monitoring laboratory costs are

Discussion

One of the many important factors to deliberate before choosing a treatment for patients with psoriasis is cost, given that therapy and work loss estimates are $1500 annually per psoriasis patient.3 This number may actually be higher; a recent study found an average annual out of pocket cost for psoriasis patients of >$2500.4 In addition, a cost analysis of systemic therapies conducted between 2000 and 2008 revealed that medication prices are increasing at a rate greater than that of general

References (29)

Cited by (0)

Funding sources: None.

Dislcosure: Dr Payette has been an adviser to Amgen. Dr D'Souza declared no conflicts of interest.

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