Topical therapies for the treatment of localized plaque psoriasis in primary care: a cost‐effectiveness analysis. (25th April 2013)

• Record Type: Journal Article
• Authors: Sawyer, L.; Samarasekera, E.J.; Wonderling, D.; Smith, C.H.
• Is Part Of: British journal of dermatology. Volume 168:Number 5(2013:May)
• Page Start: 1095
• Page End: 1105
• Publication Date: 2013-04-25
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.12261
• Languages: English
• ISSNs: 0007-0963

Abstract

<abstract abstract-type="main" xml:lang="en" id="bjd12261-abs-0001"> <title>Summary</title> <sec id="bjd12261-sec-0001" sec-type="section"> <title>Background</title> <p>Topical therapies are a mainstay of psoriasis treatment, but they vary substantially in terms of cost.</p> </sec> <sec id="bjd12261-sec-0002" sec-type="section"> <title>Objectives</title> <p>To determine the cost‐effectiveness and optimal treatment sequence for psoriasis of the trunk, limbs and scalp.</p> </sec> <sec id="bjd12261-sec-0003" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="bjd12261-sec-0004" sec-type="section"> <title>Results</title> <p>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.</p> </sec> <sec id="bjd12261-sec-0005" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>