Economic evaluation of biologic therapies for the treatment of moderate to severe psoriasis in the United States.
BACKGROUND
New biologic therapies are available for moderate to severe psoriasis.


OBJECTIVE
To determine the most cost-effective sequence of biologic treatments.


METHODS
Through modeling of the clinical pathway of biologic agents, adalimumab, alefacept, efalizumab, etanercept, and infliximab, the costs and benefits (quality-adjusted life-years [QALYs]) were determined. A decision rule determined the optimal treatment sequence comparing costs and QALYs.


RESULTS
While infliximab was found to provide the most incremental QALY and etanercept was found to be the least costly, on balance, the incremental cost-effectiveness ratio of adalimumab was the most favorable (ICER = $544/QALY). Consequently, the optimal sequence would begin with adalimumab and be followed by etanercept, infliximab, efalizumab, and alefacept, respectively. The limitations of this study are that evidence was based on indirect comparisons of biologic effectiveness, and toxicities were not included in the model.


CONCLUSIONS
In consideration of cost-effectiveness in prescribing biologics for moderate to severe psoriasis, the optimal sequence would begin with adalimumab.
Anis
Aslam H
AH
Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada. aslam.anis@ubc.ca
Bansback
Nick
N
Sizto
Sonia
S
Gupta
Shiraz R
SR
Willian
Mary K
MK
Feldman
Steve R
SR
D000068879:Adalimumab; D000077944:Alefacept; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D003362:Cost-Benefit Analysis; D003879:Dermatologic Agents / Q000191:economics* / Q000627:therapeutic use*; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000191:economics / Q000627:therapeutic use; D007155:Immunologic Factors / Q000191:economics / Q000627:therapeutic use; D000069285:Infliximab; D011565:Psoriasis / Q000188:drug therapy* / Q000191:economics*; D019057:Quality-Adjusted Life Years; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000191:economics / Q000627:therapeutic use; D014481:United States
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003879:Dermatologic Agents; D007074:Immunoglobulin G; D007155:Immunologic Factors; D018124:Receptors, Tumor Necrosis Factor; D011993:Recombinant Fusion Proteins; D000069285:Infliximab; D000077944:Alefacept; D000068879:Adalimumab; D000068800:Etanercept; C472181:efalizumab