The cost effectiveness of tapered versus abrupt discontinuation of oral cyclosporin microemulsion for the treatment of psoriasis.
OBJECTIVE
To assess the cost effectiveness of tapered versus abrupt discontinuation of a microemulsion formulation of cyclosporin in patients with chronic plaque psoriasis.


METHODS
A cost-effectiveness analysis was performed in parallel with a non-blind, multicentre, international clinical trial of the safety and efficacy of intermittent short courses of cyclosporin. Direct and indirect costs were considered within a 1-year period following randomisation.


METHODS
Patients with chronic plaque psoriasis inadequately controlled with topical treatment.


METHODS
The study was conducted from a societal perspective and was performed using data from Canada, Spain, Turkey and the UK.


METHODS
The health outcome used was the total number of systemic therapy-free days (STFDs) over the first year. The mean incremental cost-effectiveness ratio (ICER) was determined by dividing the differences in average cost per patient by the differences in average STFDs per patient.


RESULTS
The overall ICER was dominant because tapered discontinuation was associated with both lower costs and improved efficacy in comparison with abrupt discontinuation. Further analyses showed that tapered discontinuation was a cost-effective alternative to abrupt discontinuation therapy, even when a conservative definition for cost effectiveness was adopted.


CONCLUSIONS
This cost-effectiveness analysis demonstrated that tapering cyclosporin was more cost effective than abruptly stopping cyclosporin in patients with chronic plaque psoriasis.
Hakkaart-van Roijen
L
L
Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands. Hakkaart@bmg.eur.nl
Verboom
P
P
Redekop
W K
WK
Touw
K R
KR
Rutten
F F
FF
D000284:Administration, Oral; D000328:Adult; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D016572:Cyclosporine / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D004180:Direct Service Costs; D004334:Drug Administration Schedule; D017850:Economics, Pharmaceutical; D005260:Female; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic; D011565:Psoriasis / Q000188:drug therapy / Q000191:economics*; D016896:Treatment Outcome
D003879:Dermatologic Agents; D016572:Cyclosporine