title: Model for assessing the efficiency of biologic drugs in the treatment of moderate to severe psoriasis for one year in clinical practice in Spain.
abstract: BACKGROUND
  Most economic evaluations in the literature on the subject of biologic therapy for the treatment of psoriasis do not reflect normal clinical practice or consider the cost of patient management.
  
  
  OBJECTIVE
  The objective of the present study is to establish a model for assessing the efficiency of biologic therapies in the treatment of psoriasis taking into account the cost of managing treatment which, in routine clinical practice, depends on patient response.
  
  
  METHODS
  We developed a model based on a decision tree that incorporates the probability of treatment response or failure with adalimumab, etanercept, infliximab, and ustekinumab after 24 weeks of therapy (end of the induction phase). The probability in each case was calculated using data from a meta-analysis. The following direct health costs were taken into account: the cost of drugs and their administration in euro (2015). Our analysis was based on the cost of 12 months of treatment administered in a hospital setting.
  
  
  RESULTS
  According to the proposed model, the mean cost per year by initial treatment strategy was lowest for patients who started treatment with ustekinumab, although the percentage cost difference between ustekinumab and infliximab or adalimumab was less than 3%. With a fixed budget of €1,000,000, the initial treatment option that would achieve success in the largest number of patients for one year would, according to this model, be ustekinumab (66 patients), followed by infliximab (n = 62), adalimumab (n = 59), and etanercept (n = 50). Sensitivity analysis confirmed the reliability of these results. However, considering the confidence intervals of the incremental efficacy observed in the meta-analysis, the differences found are probably not significant in all the possible binary comparisons. Likewise, possible differences in actual price structures, populations, and the strategies and therapeutic objectives of each hospital could all give rise to considerable variations in real life.
  
  
  CONCLUSIONS
  The cost of managing treatment in patients who fail to achieve an acceptable response during the induction phase should also be considered since such costs are a determining factor in any assessment of treatment efficiency. To achieve the optimum allocation of resources and to treat more patients efficiently, the information provided by this analysis should be cross-checked with real data taken from actual clinical practice in Spain collected in each geographical region and hospital.
authors.affiliation: Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: lpuig@santpau.cat.
authors.forename: L
authors.initials: L
authors.lastname: Puig
authors.affiliation: Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: López-Ferrer
authors.affiliation: Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: E
authors.initials: E
authors.lastname: Vilarrasa
authors.affiliation: Janssen-Cilag S.A., Madrid, España.
authors.forename: I
authors.initials: I
authors.lastname: García
authors.affiliation: Janssen-Cilag S.A., Madrid, España.
authors.forename: R
authors.initials: R
authors.lastname: Fernández-del Olmo
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D001688:Biological Products / Q000191:economics / Q000627:therapeutic use*; D003663:Decision Trees; D000068800:Etanercept / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D011565:Psoriasis / Q000188:drug therapy*; D015203:Reproducibility of Results; D013030:Spain; D000069549:Ustekinumab / Q000627:therapeutic use
chemical_list: D001688:Biological Products; D000069285:Infliximab; D000069549:Ustekinumab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Biologic agents; Biológicos; Budget optimization; Cost-effectiveness; Coste-eficacia; Efficiency; Eficiencia; Optimización presupuestaria; Psoriasis