title: Clinical and economic impact of etanercept in real-life: a prospective, non-interventional study of etanercept in the treatment of patients with moderate to severe plaque psoriasis in private dermatologist settings (ESTHER).
abstract: BACKGROUND
  Real-life data on the therapeutic effectiveness and costs of etanercept are scarce.
  
  
  OBJECTIVE
  To assess the clinical and economic impact of etanercept in patients with psoriasis in Denmark and Norway.
  
  
  METHODS
  This prospective, non-interventional study in a private dermatologist care setting in Denmark and Norway included patients ≥18 years with moderate to severe plaque psoriasis, selected for treatment with etanercept. Assessments during 1 year from etanercept initiation included Dermatology Life Quality Index (DLQI), Self-Administered Psoriasis Area and Severity Index (SAPASI) and adverse events. Direct and indirect costs were calculated.
  
  
  RESULTS
  163 subjects were enrolled. Baseline mean SAPASI was 19.1 . Proportion of patients with ≥50% decrease in SAPASI from baseline was 85% and 81% at weeks 24 and 52. DLQI decreased significantly from 11.4 (7.0) to 3.2 (4.3) and 3.7 (4.6) at weeks 24 and 52. Total annual costs increased from 78,000 to 286,000 DKK (p<0.0001), mainly due to the cost of etanercept. Outpatient-care costs and loss-of-productivity costs decreased from 9,500 to 5,000 (p = 0.0002), and from 33,000 to 18,000 DKK (p = 0.0105), respectively. The decrease in costs was more pronounced in patients who also had psoriatic arthritis. Cost increase was greatest during the first 6 months.
  
  
  CONCLUSIONS
  Etanercept treatment was associated with decreased psoriasis severity and improved quality of life. Cost increase was driven by medication, while costs of outpatient care and loss-of-productivity decreased. Maintained improved quality of life was accompanied by decreasing cost during the second 6 month period of etanercept treatment. There were no new safety signals reported.
authors: Clinic of Dermatology, Store Torv 5, 8000 Aarhus, Denmark.
authors: Christian Grønhøj
authors: CG
authors: Larsen
authors: Clinic of Dermatology, Vejle, Denmark.
authors: Peter Hundevadt
authors: PH
authors: Andersen
authors: Department of Dermatolgy, Aarhus University hospital, Denmark.
authors: Henrik
authors: H
authors: Lorentzen
authors: The Department of Dermato-Allergology, Gentofte University Hospital, Denmark.
authors: Claus
authors: C
authors: Zachariae
authors: Clinic of Dermatology, Levanger, Norway.
authors: Theis
authors: T
authors: Huldt-Nystrøm
authors: Clinic of Dermatology Nymosvingen 2, 2609 Lillehammer, Norway.
authors: Lars Kåre
authors: LK
authors: Dotterud
authors: Pfizer Denmark, Lautrupvang 8, 2750 Ballerup, Denmark.
authors: Rose-Marie
authors: RM
authors: Lindkvist
authors: Pfizer Denmark, Lautrupvang 8, 2750 Ballerup, Denmark.
authors: Susanne
authors: S
authors: Qvitzau
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D017281:Cost of Illness; D003718:Denmark; D016527:Drug Costs / Q000706:statistics & numerical data; D000068800:Etanercept; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009664:Norway; D011331:Private Practice / Q000191:economics; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy*; D011788:Quality of Life; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept
keywords: etanercept; health economics; psoriasis; psoriatic arthritis; real-life