title: Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study).
abstract: OBJECTIVE
  To assess the costs and cost effectiveness of phototherapy with ultraviolet B light provided at home compared with outpatient ultraviolet B phototherapy for psoriasis.
  
  
  METHODS
  Cost utility, cost effectiveness, and cost minimisation analyses performed alongside a pragmatic randomised clinical trial (the PLUTO study) at the end of phototherapy (mean 17.6 weeks) and at one year after the end of phototherapy (mean 68.4 weeks).
  
  
  METHODS
  Secondary care, provided by a dermatologist in the Netherlands.
  
  
  METHODS
  196 adults with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy were recruited from the dermatology departments of 14 hospitals and were followed until the end of phototherapy. From the end of phototherapy onwards, follow-up was continued for an unselected, consecutive group of 105 patients for one year after end of phototherapy.
  
  
  METHODS
  Ultraviolet B phototherapy provided at home (intervention) and conventional outpatient ultraviolet B phototherapy (control) in a setting reflecting routine practice in the Netherlands. Both treatments used narrowband ultraviolet B lamps (TL-01).
  
  
  METHODS
  Total costs to society, quality adjusted life years (QALYs) as calculated using utilities measured by the EQ-5D questionnaire, and the number of days with a relevant treatment effect (>/=50% improvement of the baseline self administered psoriasis area and severity index (SAPASI)).
  
  
  RESULTS
  Home phototherapy is at least as effective and safe as outpatient phototherapy, therefore allowing cost minimisation analyses (simply comparing costs). The average total costs by the end of phototherapy were euro800 for home treatment and euro752 for outpatient treatment, showing an incremental cost per patient of euro48 (95% CI euro-77 to euro174). The average total costs by one year after the end of phototherapy were euro1272 and euro1148 respectively (difference euro124, 95% CI euro-155 to euro403). Cost utility analyses revealed that patients experienced equal health benefits-that is, a gain of 0.296 versus 0.291 QALY (home v outpatient) by the end of phototherapy (difference 0.0052, -0.0244 to 0.0348) and 1.153 versus 1.126 QALY by one year after the end of phototherapy (difference 0.0267, -0.024 to 0.078). Incremental costs per QALY gained were euro9276 and euro4646 respectively, both amounts well below the normally accepted standard of euro20 000 per QALY. Cost effectiveness analyses indicated that the mean number of days with a relevant treatment effect was 42.4 versus 55.3 by the end of phototherapy (difference -12.9, -23.4 to -2.4). By one year after the end of phototherapy the number of days with a relevant treatment effect were 216.5 and 210.4 respectively (6.1, -41.1 to 53.2), yielding an incremental cost of euro20 per additional day with a relevant treatment effect.
  
  
  CONCLUSIONS
  Home ultraviolet B phototherapy for psoriasis is not more expensive than phototherapy in an outpatient setting and proved to be cost effective. As both treatments are at least equally effective and patients express a preference for home treatment, the authors conclude that home phototherapy should be the primary treatment option for patients who are eligible for phototherapy with ultraviolet B light.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN83025173 and Clinicaltrials.gov NCT00150930.
authors.affiliation: Department of Dermatology/Allergology (G02.124), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands. author@koek.com
authors.forename: Mayke B G
authors.initials: MB
authors.lastname: Koek
authors.forename: Vigfús
authors.initials: V
authors.lastname: Sigurdsson
authors.forename: Huib
authors.initials: H
authors.lastname: van Weelden
authors.forename: Paul H A
authors.initials: PH
authors.lastname: Steegmans
authors.forename: Carla A F M
authors.initials: CA
authors.lastname: Bruijnzeel-Koomen
authors.forename: Erik
authors.initials: E
authors.lastname: Buskens
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006295:Health Resources / Q000706:statistics & numerical data; D006699:Home Care Services / Q000191:economics; D006801:Humans; D008875:Middle Aged; D011565:Psoriasis / Q000191:economics / Q000532:radiotherapy*; D019057:Quality-Adjusted Life Years; D016037:Single-Blind Method; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000191:economics*
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