title: An observational study of the real-life management of psoriasis patients treated with etanercept according to the new reimbursement criteria (in Belgium).
abstract: BACKGROUND
  This study described the number of patients with psoriasis receiving flexible (continuous/intermittent) dosing with etanercept (ETN) and the real-world economic impact.
  
  
  METHODS
  BeFlex was a prospective, observational study with a ≥1 year follow-up. Patients ≥18 years with moderate-to-severe psoriasis who were starting or re-starting treatment with ETN in alignment with Belgian reimbursement criteria were included. Cost of ETN was compared with cost of adalimumab, ustekinumab and infliximab using estimates from the National Institute for Sickness and Disability Insurance (INAMI/RIZIV).
  
  
  RESULTS
  In the flexible-dosing cohort (n = 121 with dose-regimen data), 66% were treated continuously and 34% intermittently. Baseline characteristics were similar across dosing cohorts. In the per-protocol cohort (n = 138), average ETN treatment duration/year was 40 weeks; 43 weeks continuous and 33 weeks intermittent. The overall mean interruption duration was 3.9 weeks/treatment cycle; 0.2 week continuous and 11.1 weeks intermittent. Mean dose/year was 2065 mg; 2182 mg continuous and 1660 mg intermittent. Flexible ETN dosing reduced the cost by 20% versus INAMI/RIZIV estimates. The theoretical cost of the other continuously-dosed biologics was 28-44% higher than that of flexible ETN.
  
  
  CONCLUSIONS
  Approximately one-third of Belgian patients received intermittent ETN treatment. Flexible ETN dosing was more cost-effective than treatment with biologic agents that require continuous dosing.
authors.affiliation: a Department of Dermatology , University Hospital Sint-Rafaël , Leuven , Belgium .
authors.forename: Siegfried
authors.initials: S
authors.lastname: Segaert
authors.affiliation: b Dermatology Department , Cliniques Universitaires St-Luc UCL , Brussels , Belgium , and.
authors.forename: Pierre-Dominique
authors.initials: PD
authors.lastname: Ghislain
authors.affiliation: c Medical Department , Pfizer SA/NV , Brussels , Belgium.
authors.forename: Caroline
authors.initials: C
authors.lastname: Boone
mesh_terms: D000068879:Adalimumab / Q000191:economics; D000328:Adult; D000368:Aged; D001530:Belgium; D001688:Biological Products / Q000191:economics; D003362:Cost-Benefit Analysis; D000068800:Etanercept / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000191:economics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy* / Q000191:economics; D000069549:Ustekinumab / Q000191:economics
chemical_list: D001688:Biological Products; D000069285:Infliximab; D000069549:Ustekinumab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Continuous dosing; cost-effectiveness; etanercept; flexible dosing; intermittent dosing