title: Efficacy and cost-efficacy of biologic therapies for moderate to severe psoriasis: a meta-analysis and cost-efficacy analysis using the intention-to-treat principle.
abstract: BACKGROUND
  Compared to conventional therapies, biologics are more effective but expensive in treating psoriasis.
  
  
  OBJECTIVE
  To evaluate the efficacy and cost-efficacy of biologic therapies for psoriasis.
  
  
  METHODS
  We conducted a meta-analysis to calculate the efficacy of etanercept, adalimumab, infliximab, and ustekinumab for at least 75% reduction in the Psoriasis Area and Severity Index score (PASI 75) and Physician's Global Assessment clear/minimal (PGA 0/1). The cost-efficacy was assessed by calculating the incremental cost-effectiveness ratio (ICER) per subject achieving PASI 75 and PGA 0/1.
  
  
  RESULTS
  The incremental efficacy regarding PASI 75 was 55% (95% confidence interval (95% CI) 38%-72%), 63% (95% CI 59%-67%), 71% (95% CI 67%-76%), 67% (95% CI 62%-73%), and 72% (95% CI 68%-75%) for etanercept, adalimumab, infliximab, and ustekinumab 45 mg and 90 mg, respectively. The corresponding 6-month ICER regarding PASI 75 was $32,643 (best case $24,936; worst case $47,246), $21,315 (best case $20,043; worst case $22,760), $27,782 (best case $25,954; worst case $29,440), $25,055 (best case $22,996; worst case $27,075), and $46,630 (best case $44,765; worst case $49,373), respectively. The results regarding PGA 0/1 were similar.
  
  
  CONCLUSIONS
  Infliximab and ustekinumab 90 mg had the highest efficacy. Meanwhile, adalimumab had the best cost-efficacy, followed by ustekinumab 45 mg and infliximab.
authors.affiliation: Department of Dermatology and Centre for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan ; College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
authors.forename: Ching-Chi
authors.identifier: 0000-0001-5699-0283
authors.initials: CC
authors.lastname: Chi
authors.affiliation: Department of Dermatology, Far Eastern Memorial Hospital, Banciao, New Taipei 22060, Taiwan ; Oriental Institute of Technology, New Taipei 22061, Taiwan.
authors.forename: Shu-Hui
authors.identifier: 0000-0003-1028-5030
authors.initials: SH
authors.lastname: Wang
mesh_terms: D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use; D001691:Biological Therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000191:economics / Q000627:therapeutic use; D000069285:Infliximab; D057194:Intention to Treat Analysis; D011565:Psoriasis / Q000191:economics / Q000473:pathology / Q000628:therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D016896:Treatment Outcome; D000069549:Ustekinumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000069285:Infliximab; D000069549:Ustekinumab; D000068879:Adalimumab; D000068800:Etanercept