Treatment of moderate to severe plaque psoriasis with biologics: analysis of the additional cost of temporary dose escalation vs switch to another biologic after failure of maintenance therapy.
BACKGROUND
In the event of failure of maintenance therapy with biologic agents for moderate to severe plaque psoriasis, the possible approaches are to switch to another agent or escalate the dose (generally by increased dosing frequency). Knowledge of the economic impact of the 2 alternatives would be extremely useful for therapeutic decision making.


OBJECTIVE
The present analysis aimed to determine the moment in which the annualized additional cost of escalation exceeds a specified cost overrun.


METHODS
Based on the purchase cost (average wholesale price) of approved biologics for the treatment of moderate to severe psoriasis, the number of weeks of escalation of the initial biologic until the annualized cost of dose escalation ran €1000 over the cost of switching to another biologic was calculated for a typical patient weighing 80 kg.


RESULTS
According to this model, switching to another biologic is always cost effective, with adalimumab followed by ustekinumab the best choices in this respect. Ustekinumab allows for a longer trial escalation period (2 to 4 injections) before the cost overrun threshold is reached, whereas the threshold is reached in a single infusion if a patient is on infliximab.


CONCLUSIONS
The study does not take into account the differential efficacy of the various biologic therapies as rescue treatment for failure of maintenance therapy given the lack of scientific evidence. The results nevertheless show substantial differences in the period during which treatment can be intensified before reaching the preset cost overrun.
Servicio deDermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España. Electronic address: lpuig@santpau.cat.
L
L
Puig
D001688:Biological Products / Q000008:administration & dosage* / Q000191:economics*; D003365:Costs and Cost Analysis; D006801:Humans; D060046:Maintenance Chemotherapy; D011565:Psoriasis / Q000188:drug therapy*; D012720:Severity of Illness Index; D017211:Treatment Failure
D001688:Biological Products
Adalimumab; Cambio (switching); Escalation; Etanercept; Fracaso secundario; Infliximab; Intensificación; Maintenance failure; Psoriasis; Switching; Ustekinumab