Cost-effectiveness analysis of a psoriasis care instruction programme with dithranol compared with UVB phototherapy and inpatient dithranol treatment.
BACKGROUND
This study was part of a large national cost-effectiveness analysis, and was funded by the National Fund for Investigational Medicine of the Health Care Insurance Board.


OBJECTIVE
To compare the costs of treatment of moderate to severe psoriasis by dithranol short contact therapy in a care instruction programme (short contact therapy) with ultraviolet B phototherapy (UVB) and inpatient dithranol treatment (inpatient treatment), and relate these costs to treatment effectiveness.


METHODS
An open randomized controlled multicentre study was performed. The costs (both medical and non-medical) were calculated for the following periods: during treatment, per month during remission, after a relapse, and following an unsuccessful treatment. The effectiveness measures were the clinical response rate and the number of clearance days during follow-up.


RESULTS
The data from 216 patients were analysed. The mean overall costs per patient during treatment were euro;1641, euro;1258 and euro;7706 for short contact treatment, UVB and inpatient treatment, respectively. During the clearance period the mean costs per month per patient were euro;19, euro;5 and euro;25, respectively. The clinical response rates were 57%, 57% and 85%, respectively. The mean number of clearance-days after short contact treatment was 160 [median 119; interquartile range (0-357)], which was not significantly different from the other two strategies: 211 clearance-days after inpatient treatment [241 (99-350)] and 136 clearance-days after UVB [81 (0-266)].


CONCLUSIONS
Short contact treatment is an attractive alternative for patients with moderate to severe psoriasis currently treated by inpatient treatment, as the costs of short contact treatment were significantly lower and the number of clearance days was comparable. Considering the higher costs, short contact treatment is not a first choice treatment when compared with UVB.
Hartman
M
M
Department of Medical Technology Assessment (253 MTA), University Medical Centre St Radbound, PO Box 9101, 6500 HB Nijmegen, The Netherlands. m.hartman@mie.kun.nl
Prins
M
M
Swinkels
O Q J
OQ
Severens
J L
JL
De Boo
Th
T
Van Der Wilt
G J
GJ
Van De Kerkhof
P C M
PC
Van Der Valk
P G M
PG
D000287:Administration, Topical; D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D000875:Anthralin / Q000191:economics / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000191:economics / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011565:Psoriasis / Q000188:drug therapy* / Q000191:economics / Q000532:radiotherapy; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000191:economics*
D000893:Anti-Inflammatory Agents; D000875:Anthralin