title: Apremilast for the Treatment of Moderate to Severe Plaque Psoriasis: A Critique of the Evidence.
abstract: As part of the National Institute for Health and Care Excellence's (NICE) single technology appraisal (STA) process, apremilast was assessed to determine the clinical and cost effectiveness of its use in the treatment of moderate to severe plaque psoriasis in two patient populations, differentiated by the severity of the patient's Psoriasis Area Severity Index (PASI) score. The Centre for Reviews and Dissemination (CRD) and the Centre for Health Economics (CHE) Technology Appraisal Group at the University of York was commissioned to act as the evidence review group (ERG). This article provides a summary of the company's submission, the ERG report and NICE's subsequent guidance. In the company's initial submission, a sequence of treatments including apremilast was found to be both more effective and cheaper than a comparator sequence without it in both populations considered. However, this result was found to be highly sensitive to a series of assumptions made by the company, primarily reflecting the costs of best supportive care once no further treatments are available, and the source of utility estimates. A re-estimation of the cost effectiveness of apremilast by the ERG suggested that the apremilast sequence in the two populations was more effective, but due to high additional costs was not indicative of a cost-effective use of NHS resources. As such, in the final appraisal decision NICE concluded that apremilast was not cost effective in either population.
authors.affiliation: Centre for Health Economics (CHE), University of York, York, YO10 5DD, UK. Sebastian.hinde@york.ac.uk.
authors.forename: Sebastian
authors.identifier: 0000-0002-7117-4142
authors.initials: S
authors.lastname: Hinde
authors.affiliation: Centre for Reviews and Dissemination (CRD), University of York, York, UK.
authors.forename: Ros
authors.initials: R
authors.lastname: Wade
authors.affiliation: Centre for Health Economics (CHE), University of York, York, YO10 5DD, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Palmer
authors.affiliation: Centre for Reviews and Dissemination (CRD), University of York, York, UK.
authors.forename: Nerys
authors.initials: N
authors.lastname: Woolacott
authors.affiliation: Centre for Health Economics (CHE), University of York, York, YO10 5DD, UK.
authors.forename: Eldon
authors.initials: E
authors.lastname: Spackman
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D006801:Humans; D011565:Psoriasis / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D012720:Severity of Illness Index; D013673:Technology Assessment, Biomedical; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D013792:Thalidomide; C505730:apremilast
references.citation: Br J Dermatol. 2015 Dec;173(6):1387-99
references.pmid: 26357944
references.citation: Pharmacoeconomics. 2015 Feb;33(2):137-48
references.pmid: 25213036
references.citation: Lancet. 2012 Aug 25;380(9843):738-46
references.pmid: 22748702
references.citation: Health Technol Assess. 2006 Sep;10(31):iii-iv, xiii-xvi, 1-239
references.pmid: 16948890
references.citation: Pharmacoeconomics. 2015 Aug;33(8):833-47
references.pmid: 25851485
references.citation: Health Qual Life Outcomes. 2015 Sep 15;13:145
references.pmid: 26374709
references.citation: Pharmacoeconomics. 2016 Mar;34(3):245-57
references.pmid: 26477040
references.citation: J Invest Dermatol. 2013 Feb;133(2):377-85
references.pmid: 23014338
references.citation: Pharmacoeconomics. 2015 Nov;33(11):1187-94
references.pmid: 26017401
references.citation: Pharmacoeconomics. 2015 Mar;33(3):225-33
references.pmid: 25424495
references.citation: Br J Dermatol. 2010 Oct;163(4):807-16
references.pmid: 20662837