title: Cost-effectiveness of systemic treatments for moderate-to-severe psoriasis in the German health care setting.
abstract: Systemic treatments of moderate-to-severe psoriasis differ substantially in terms of effectiveness and costs. Comprehensive economic-evaluations of all systemic treatments for psoriasis from a societal perspective are missing. The objective of our study was to compare the cost-effectiveness all systemic treatments approved for moderate-to-severe psoriasis from a societal perspective, by including all cost categories. An incremental cost-effectiveness-analysis was performed for all systemic treatments for psoriasis, currently recommended by the German S3-Guideline i.e. methotrexate, cyclosporine, fumaric acid esters, and retinoids, adalimumab, etanercept, infliximab and ustekinumab. We used a Markov model with time-dependent transition probabilities and a time horizon of 2 years to investigate incremental cost-effectiveness ratios. Both direct and indirect costs were considered to reflect the societal perspective. Effectiveness outcome was PASI-75 response. One-way and probabilistic sensitivity analyses explored the effect of treatment duration, discount rate, effectiveness, and the perspective (societal vs. healthcare system) on the findings. According to the base-case analysis a cost-effective treatment pathway for moderate-to-severe psoriasis starts with methotrexate, followed by ustekinumab 90 mg and infliximab, if methotrexate does not achieve or maintain PASI-75 response. Sensitivity analyses confirmed the general robustness of these findings with methotrexate being most cost-effective. However, from a third-party-payer perspective (without indirect cost) conventional therapies were generally more cost-effective than biologics. From a value-based healthcare perspective, methotrexate should be the systemic treatment of first choice, ustekinumab 90 mg second choice and infliximab third choice for patients with moderate-to-severe psoriasis. From a societal perspective, the other treatments are less efficient according to our model. From a third-party-payer perspective conventional therapies are more cost-effective than biologics.
authors.affiliation: Centre for Evidence-based Healthcare, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. denise.kuester@uniklinikum-dresden.de.
authors.forename: Denise
authors.initials: D
authors.lastname: Küster
authors.affiliation: Division of Evidence Based Medicine (DEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité, Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Nast
authors.affiliation: Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Gerdes
authors.affiliation: Department of Dermatology, Venereology, and Allergology, J.W. Goethe-University Hospital, Frankfurt, Germany.|Evidence-based Medicine Frankfurt, Institute for General Practice, Goethe University, Frankfurt, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Weberschock
authors.affiliation: Department of Dermatology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Wozel
authors.affiliation: Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Mandy
authors.initials: M
authors.lastname: Gutknecht
authors.affiliation: Centre for Evidence-based Healthcare, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schmitt
mesh_terms: D001688:Biological Products / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D000069285:Infliximab / Q000191:economics* / Q000627:therapeutic use; D007349:Insurance, Health, Reimbursement; D008727:Methotrexate / Q000191:economics* / Q000627:therapeutic use; D011565:Psoriasis / Q000188:drug therapy* / Q000191:economics*; D016896:Treatment Outcome; D000069549:Ustekinumab / Q000191:economics* / Q000627:therapeutic use
chemical_list: D001688:Biological Products; D000069285:Infliximab; D000069549:Ustekinumab; D008727:Methotrexate
keywords: Biologic; Cost-effectiveness; Efficiency; Health economy; Psoriasis; Systemic treatment