title: Psoriasis treatment and management - a systematic review of full economic evaluations.
abstract: BACKGROUND
  Psoriasis frequently requires lifetime control and current therapies vary significantly in price. High-quality economic evaluations are necessary to determine if higher-cost treatments are value for money.
  
  
  OBJECTIVE
  This review aims to identify the cost-effectiveness of psoriasis care (whether more expensive interventions are associated with savings in health care and psoriasis management and/or improve patients' health); assess the level of uncertainty and transferability of this evidence to policy and practice; and, identify future research needs.
  
  
  METHODS
  Searches of electronic databases Embase, MEDLINE and NHS EED for full economic evaluations were conducted in January 2012 (updated April 2014). Included articles were screened, selected and critically appraised using predefined inclusion criteria and data extraction forms: 1355 articles were identified; 37 papers reporting 71 comparisons met the inclusion criteria. Treatments evaluated were systemic (n = 45), topical (n = 22), phototherapies (n = 14) and combination (n = 4).
  
  
  RESULTS
  Despite a significant number of recent economic evaluations, the cost-effectiveness of all therapies remains unclear. This uncertainty arises from a diversity in settings, perspective and design. Economic evaluations were constrained by limited availability of high-quality short- and long-term head-to-head comparisons of the effectiveness, safety and adherence of different interventions.
  
  
  CONCLUSIONS
  The economic evidence is dominated by comparisons of interventions to placebo, with implicit comparisons of different therapies. There is a lack of evaluations of service model innovations to deliver complex packages of care for psoriasis. Primary and secondary integrated clinical and economic research is needed to address the limitations and to identify patient preferences and barriers/facilitators to treatment.
authors.affiliation: Centre for Health Economics, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, U.K.
authors.forename: M P
authors.initials: MP
authors.lastname: Hamilton
authors.forename: D
authors.initials: D
authors.lastname: Ntais
authors.forename: C E M
authors.initials: CE
authors.lastname: Griffiths
authors.forename: L M
authors.initials: LM
authors.lastname: Davies
mesh_terms: D000305:Adrenal Cortex Hormones / Q000191:economics / Q000627:therapeutic use; D001688:Biological Products / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003879:Dermatologic Agents / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D011701:PUVA Therapy / Q000191:economics; D011565:Psoriasis / Q000191:economics* / Q000628:therapy; D014807:Vitamin D / Q000191:economics / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D001688:Biological Products; D003879:Dermatologic Agents; D014807:Vitamin D