Topical therapies for the treatment of localized plaque psoriasis in primary care: a cost-effectiveness analysis

L Sawyer; E J Samarasekera; D Wonderling; C H Smith

doi:10.1111/bjd.12261

Topical therapies for the treatment of localized plaque psoriasis in primary care: a cost-effectiveness analysis

L Sawyer, E J Samarasekera, D Wonderling, C H Smith

Dermatology

Research output: Contribution to journal › Article › peer-review

19 Citations (Scopus)

Abstract

BACKGROUND: Topical therapies are a mainstay of psoriasis treatment, but they vary substantially in terms of cost.

OBJECTIVES: To determine the cost-effectiveness and optimal treatment sequence for psoriasis of the trunk, limbs and scalp.

METHODS: Probabilities of response from a network meta-analysis were used to determine the short-term efficacy of topical therapies. Longer-term outcomes, including relapse, were informed by published evidence and clinical opinion. Benefits of treatment were measured as quality-adjusted life years (QALYs). Direct costs included topical agents, primary and secondary care visits and second-line therapies for treatment failures.

RESULTS: For the trunk and limbs, initial treatment with a two-compound formulation (TCF) product containing vitamin D and potent corticosteroid provided the most QALYs, followed by separate morning and evening application of vitamin D and potent corticosteroid [two-compound application, TCA (am/pm)], and then twice-daily potent corticosteroids. The use of twice-daily potent corticosteroids was the most cost-effective first-line strategy (incremental cost-effectiveness ratio £ 20,000 per QALY), followed by TCA (am/pm) (£ 22,658 per QALY) and TCF product (£ 179,439 per QALY). For scalp psoriasis, initial treatment with very potent corticosteroids generated the most QALYs, followed by TCF product and then potent corticosteroids. Very potent corticosteroids were the most cost-effective treatment but, if too aggressive, potent corticosteroids were optimal followed by TCF product (£ 219,846 per QALY). The cost-effectiveness of second- and third-line topical agents varied with the assumptions made.

CONCLUSIONS: Potent corticosteroids, used alone or in combination with vitamin D, are the most cost-effective treatment for patients with psoriasis of the trunk and limbs. Potent or very potent corticosteroids are the most cost-effective treatment for patients with scalp psoriasis.

Original language	English
Pages (from-to)	1095-105
Number of pages	11
Journal	British Journal of Dermatology
Volume	168
Issue number	5
DOIs	https://doi.org/10.1111/bjd.12261
Publication status	Published - May 2013

Keywords

Administration, Topical
Adrenal Cortex Hormones
Cost-Benefit Analysis
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Extremities
Humans
Meta-Analysis as Topic
Models, Theoretical
Primary Health Care
Psoriasis
Quality-Adjusted Life Years
Scalp
Torso
Treatment Outcome
Vitamin D

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10.1111/bjd.12261

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@article{f0a258d865284d58a4f00ec8042b567f,

title = "Topical therapies for the treatment of localized plaque psoriasis in primary care: a cost-effectiveness analysis",

abstract = "BACKGROUND: Topical therapies are a mainstay of psoriasis treatment, but they vary substantially in terms of cost.OBJECTIVES: To determine the cost-effectiveness and optimal treatment sequence for psoriasis of the trunk, limbs and scalp.METHODS: Probabilities of response from a network meta-analysis were used to determine the short-term efficacy of topical therapies. Longer-term outcomes, including relapse, were informed by published evidence and clinical opinion. Benefits of treatment were measured as quality-adjusted life years (QALYs). Direct costs included topical agents, primary and secondary care visits and second-line therapies for treatment failures.RESULTS: For the trunk and limbs, initial treatment with a two-compound formulation (TCF) product containing vitamin D and potent corticosteroid provided the most QALYs, followed by separate morning and evening application of vitamin D and potent corticosteroid [two-compound application, TCA (am/pm)], and then twice-daily potent corticosteroids. The use of twice-daily potent corticosteroids was the most cost-effective first-line strategy (incremental cost-effectiveness ratio £ 20,000 per QALY), followed by TCA (am/pm) (£ 22,658 per QALY) and TCF product (£ 179,439 per QALY). For scalp psoriasis, initial treatment with very potent corticosteroids generated the most QALYs, followed by TCF product and then potent corticosteroids. Very potent corticosteroids were the most cost-effective treatment but, if too aggressive, potent corticosteroids were optimal followed by TCF product (£ 219,846 per QALY). The cost-effectiveness of second- and third-line topical agents varied with the assumptions made.CONCLUSIONS: Potent corticosteroids, used alone or in combination with vitamin D, are the most cost-effective treatment for patients with psoriasis of the trunk and limbs. Potent or very potent corticosteroids are the most cost-effective treatment for patients with scalp psoriasis.",

keywords = "Administration, Topical, Adrenal Cortex Hormones, Cost-Benefit Analysis, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Therapy, Combination, Extremities, Humans, Meta-Analysis as Topic, Models, Theoretical, Primary Health Care, Psoriasis, Quality-Adjusted Life Years, Scalp, Torso, Treatment Outcome, Vitamin D",

author = "L Sawyer and Samarasekera, {E J} and D Wonderling and Smith, {C H}",

note = "{\textcopyright} 2013 The Authors BJD {\textcopyright} 2013 British Association of Dermatologists.",

year = "2013",

month = may,

doi = "10.1111/bjd.12261",

language = "English",

volume = "168",

pages = "1095--105",

journal = "British Journal of Dermatology",

issn = "0007-0963",

publisher = "John Wiley & Sons, Ltd (10.1111)",

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TY - JOUR

T1 - Topical therapies for the treatment of localized plaque psoriasis in primary care

T2 - a cost-effectiveness analysis

AU - Sawyer, L

AU - Samarasekera, E J

AU - Wonderling, D

AU - Smith, C H

PY - 2013/5

Y1 - 2013/5

N2 - BACKGROUND: Topical therapies are a mainstay of psoriasis treatment, but they vary substantially in terms of cost.OBJECTIVES: To determine the cost-effectiveness and optimal treatment sequence for psoriasis of the trunk, limbs and scalp.METHODS: Probabilities of response from a network meta-analysis were used to determine the short-term efficacy of topical therapies. Longer-term outcomes, including relapse, were informed by published evidence and clinical opinion. Benefits of treatment were measured as quality-adjusted life years (QALYs). Direct costs included topical agents, primary and secondary care visits and second-line therapies for treatment failures.RESULTS: For the trunk and limbs, initial treatment with a two-compound formulation (TCF) product containing vitamin D and potent corticosteroid provided the most QALYs, followed by separate morning and evening application of vitamin D and potent corticosteroid [two-compound application, TCA (am/pm)], and then twice-daily potent corticosteroids. The use of twice-daily potent corticosteroids was the most cost-effective first-line strategy (incremental cost-effectiveness ratio £ 20,000 per QALY), followed by TCA (am/pm) (£ 22,658 per QALY) and TCF product (£ 179,439 per QALY). For scalp psoriasis, initial treatment with very potent corticosteroids generated the most QALYs, followed by TCF product and then potent corticosteroids. Very potent corticosteroids were the most cost-effective treatment but, if too aggressive, potent corticosteroids were optimal followed by TCF product (£ 219,846 per QALY). The cost-effectiveness of second- and third-line topical agents varied with the assumptions made.CONCLUSIONS: Potent corticosteroids, used alone or in combination with vitamin D, are the most cost-effective treatment for patients with psoriasis of the trunk and limbs. Potent or very potent corticosteroids are the most cost-effective treatment for patients with scalp psoriasis.

AB - BACKGROUND: Topical therapies are a mainstay of psoriasis treatment, but they vary substantially in terms of cost.OBJECTIVES: To determine the cost-effectiveness and optimal treatment sequence for psoriasis of the trunk, limbs and scalp.METHODS: Probabilities of response from a network meta-analysis were used to determine the short-term efficacy of topical therapies. Longer-term outcomes, including relapse, were informed by published evidence and clinical opinion. Benefits of treatment were measured as quality-adjusted life years (QALYs). Direct costs included topical agents, primary and secondary care visits and second-line therapies for treatment failures.RESULTS: For the trunk and limbs, initial treatment with a two-compound formulation (TCF) product containing vitamin D and potent corticosteroid provided the most QALYs, followed by separate morning and evening application of vitamin D and potent corticosteroid [two-compound application, TCA (am/pm)], and then twice-daily potent corticosteroids. The use of twice-daily potent corticosteroids was the most cost-effective first-line strategy (incremental cost-effectiveness ratio £ 20,000 per QALY), followed by TCA (am/pm) (£ 22,658 per QALY) and TCF product (£ 179,439 per QALY). For scalp psoriasis, initial treatment with very potent corticosteroids generated the most QALYs, followed by TCF product and then potent corticosteroids. Very potent corticosteroids were the most cost-effective treatment but, if too aggressive, potent corticosteroids were optimal followed by TCF product (£ 219,846 per QALY). The cost-effectiveness of second- and third-line topical agents varied with the assumptions made.CONCLUSIONS: Potent corticosteroids, used alone or in combination with vitamin D, are the most cost-effective treatment for patients with psoriasis of the trunk and limbs. Potent or very potent corticosteroids are the most cost-effective treatment for patients with scalp psoriasis.

KW - Administration, Topical

KW - Adrenal Cortex Hormones

KW - Cost-Benefit Analysis

KW - Dose-Response Relationship, Drug

KW - Drug Administration Schedule

KW - Drug Therapy, Combination

KW - Extremities

KW - Humans

KW - Meta-Analysis as Topic

KW - Models, Theoretical

KW - Primary Health Care

KW - Psoriasis

KW - Quality-Adjusted Life Years

KW - Scalp

KW - Torso

KW - Treatment Outcome

KW - Vitamin D

U2 - 10.1111/bjd.12261

DO - 10.1111/bjd.12261

M3 - Article

C2 - 23374249

SN - 0007-0963

VL - 168

SP - 1095

EP - 1105

JO - British Journal of Dermatology

JF - British Journal of Dermatology

IS - 5

ER -

Topical therapies for the treatment of localized plaque psoriasis in primary care: a cost-effectiveness analysis

Abstract

Keywords

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