Cost-effectiveness comparison of therapy for psoriasis with a methotrexate-based regimen versus a rotation regimen of modified cyclosporine and methotrexate.
BACKGROUND
Because health care resources are limited, therapeutic regimens should be assessed for their relative costs and effectiveness.


OBJECTIVE
We assessed cost-effectiveness for treating psoriasis using two strategies: one consisted principally of methotrexate and the other was principally a rotational schedule of modified cyclosporine (Neoral) with methotrexate.


METHODS
We performed a cost-effectiveness analysis using a computerized decision analytic model of simulated patients with moderate to severe psoriasis. Patients were randomly assigned to receive treatment with one of the two strategies. Direct costs included acquisition of medications, laboratory and physician fees, and costs of treating side effects. Because of uncertainty regarding rates of clearing of psoriasis, the relative efficacy of methotrexate and cyclosporine was varied over a wide range in a sensitivity analysis.


RESULTS
In the base case over a 10-year treatment period, the methotrexate strategy cost $33,000 and provided approximately 2 years clear of psoriasis compared with $38,000 and approximately 4 years clear of psoriasis for the rotational strategy. When the relative effectiveness of cyclosporine to methotrexate in clearing psoriasis varied from approximately 1 to 20, the rotational strategy cost from $4100 to $2700 per incremental clear year.


CONCLUSIONS
In selecting therapies for psoriasis patients, both costs and effectiveness should be considered. In this simulation, patients could obtain additional periods clear of psoriasis at an incremental cost by using cyclosporine in rotation with methotrexate. If even a small utility gain accompanies the complete clearing of psoriasis, such a strategy may be a worthwhile investment of resources comparable to other healthcare interventions.
Ellis
Charles N
CN
Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA.
Reiter
Kristin L
KL
Bandekar
Rajesh R
RR
Fendrick
A Mark
AM
D003362:Cost-Benefit Analysis; D016572:Cyclosporine / Q000008:administration & dosage* / Q000191:economics*; D004334:Drug Administration Schedule; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000191:economics*; D018803:Models, Economic; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
D016572:Cyclosporine; D008727:Methotrexate