Psoriasis treatment and management – a systematic review of full economic evaluations. (11th February 2015)

• Record Type: Journal Article
• Authors: Hamilton, M.P.; Ntais, D.; Griffiths, C.E.M.; Davies, L.M.
• Is Part Of: British journal of dermatology. Volume 172:Number 3(2015:Mar.)
• Page Start: 574
• Page End: 583
• Publication Date: 2015-02-11
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.13486
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background: Psoriasis frequently requires lifetime control and current therapies vary significantly in price. High‐quality economic evaluations are necessary to determine if higher‐cost treatments are value for money. Objectives: This review aims to identify the cost‐effectiveness of psoriasis care (whether more expensive interventions are associated with savings in health care and psoriasis management and/or improve patients' health); assess the level of uncertainty and transferability of this evidence to policy and practice; and, identify future research needs. Methods: Searches of electronic databases Embase, MEDLINE and NHS EED for full economic evaluations were conducted in January 2012 (updated April 2014). Included articles were screened, selected and critically appraised using predefined inclusion criteria and data extraction forms: 1355 articles were identified; 37 papers reporting 71 comparisons met the inclusion criteria. Treatments evaluated were systemic ( n = 45), topical ( n = 22), phototherapies ( n = 14) and combination ( n = 4). Results: Despite a significant number of recent economic evaluations, the cost‐effectiveness of all therapies remains unclear. This uncertainty arises from a diversity in settings, perspective and design. Economic evaluations were constrained by limited availability of high‐quality short‐ and long‐term head‐to‐head comparisons of the effectiveness, safety and adherence of different interventions. Conclusions: The economic evidence is dominated by comparisons of interventions to placebo, with implicit comparisons of different therapies. There is a lack of evaluations of service model innovations to deliver complex packages of care for psoriasis. Primary and secondary integrated clinical and economic research is needed to address the limitations and to identify patient preferences and barriers/facilitators to treatment. Abstract : What's already known about this topic? Current medication can provide effective control of psoriasis symptoms. The cost of treatment can be high, but may be cost‐effective. What does this study add? A comprehensive summary and critique of full economic evaluations of psoriasis treatment and management published between January 1998 and April 2014. Identification of key methodological issues and reasons why estimates of cost‐effectiveness are uncertain. Research recommendations to inform practice and policy for the integrated care of people with psoriasis.