title: A pharmacoeconomic analysis of topical therapies for patients with mild-to-moderate stable plaque psoriasis: a US study.
abstract: 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.
authors.affiliation: Health Economics Research, Secaucus, New Jersey 07094, USA.
authors.forename: A
authors.initials: A
authors.lastname: Marchetti
authors.forename: K
authors.initials: K
authors.lastname: LaPensee
authors.forename: P
authors.initials: P
authors.lastname: An
mesh_terms: D000287:Administration, Topical; D002117:Calcitriol / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003879:Dermatologic Agents / Q000191:economics* / Q000627:therapeutic use*; D005447:Fluocinonide / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007349:Insurance, Health, Reimbursement; D009539:Nicotinic Acids / Q000191:economics / Q000627:therapeutic use; D011565:Psoriasis / Q000188:drug therapy* / Q000191:economics*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014481:United States; D012176:Retinoids
chemical_list: D002117:Calcitriol; D003879:Dermatologic Agents; D005447:Fluocinonide; D009539:Nicotinic Acids; C055085:calcipotriene; C086827:tazarotene; D012176:Retinoids