Costs of treatment in patients with moderate to severe plaque psoriasis: economic analysis in a randomized controlled comparison of methotrexate and cyclosporine.
OBJECTIVE
To document and compare the costs of treatment of psoriasis with 2 established systemic agents that differ substantially in their unit costs: methotrexate vs cyclosporine.


METHODS
Cost-minimization analysis within a randomized controlled trial.


METHODS
Outpatient dermatology department at an academic hospital.


METHODS
Adults with moderate to severe plaque psoriasis, with no previous methotrexate or cyclosporine treatment.


METHODS
Sixteen weeks of treatment with methotrexate or cyclosporine and an additional 36 weeks of follow-up.


METHODS
Direct and indirect medical and nonmedical costs associated with resource utilization during treatment and follow-up.


RESULTS
Average cumulative total costs associated with 16 weeks of treatment were 1593 US dollars for methotrexate and 2114 US dollars for cyclosporine (521 US dollars less for methotrexate); during 36 weeks of follow-up, these costs were 2418 US dollars and 2306 US dollars, respectively. The overall difference in cumulative 1-year costs was 409 US dollars, or approximately 10% of the total costs.


CONCLUSIONS
After 1 year, the overall difference in total costs between methotrexate and cyclosporine for 16 weeks of treatment and follow-up is relatively small. Systemic medication costs are only a fraction of the costs directly and indirectly generated by utilization of health care resources and associated with individual patients rather than with methotrexate or cyclosporine. Economic arguments can be supportive of but not decisive for individual patient decisions and guidelines for systemic therapy. Rational decision making for the treatment of psoriasis may include costs only within a long-term horizon and may consider the societal and patient benefits of different alternatives.
Opmeer
Brent C
BC
Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands.
Heydendael
Vera M R
VM
De Borgie
Corianne A J M
CA
Spuls
Phyllis I
PI
Bossuyt
Patrick M M
PM
Bos
Jan D
JD
De Rie
Menno A
MA
D000284:Administration, Oral; D000328:Adult; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D016572:Cyclosporine / Q000008:administration & dosage* / Q000191:economics; D003880:Dermatology / Q000191:economics; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000191:economics; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000191:economics; D009426:Netherlands; D010044:Outpatient Clinics, Hospital / Q000191:economics; D011565:Psoriasis / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D012720:Severity of Illness Index; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D008727:Methotrexate