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Biologicals and small molecules in psoriasis: A systematic review of economic evaluations

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  • Christian Kromer
  • Daniel Celis
  • Diana Sonntag
  • Wiebke K Peitsch

Abstract

Biological therapy for moderate-to-severe psoriasis is highly effective but cost-intensive. This systematic review aimed at analyzing evidence on the cost-effectiveness of biological treatment of moderate-to-severe psoriasis. A literature search was conducted until 30/06/2017 in PubMed, Cochrane Library, LILACS, and EconLit. The quality of identified studies was assessed with the checklist by the Centre for Reviews and Dissemination guidance. Out of 482 records, 53 publications were eligible for inclusion. Half of the studies met between 20 and 25 of the quality checklist items, displaying moderate quality. Due to heterogeneity of studies, a qualitative synthesis was conducted. Cost ranges per outcome were enormous across different studies due to diversity in assumptions and model design. Pairwise comparisons of biologicals revealed conflicting results. Overall, adalimumab appeared to be most cost-effective (100% of all aggregated pairwise comparisons), followed by ustekinumab (66.7%), and infliximab (60%). However, in study conclusions most recent publications favored secukinumab and apremilast (75% and 60% of the studies investigating these medications). Accepted willingness-to-pay thresholds varied between 30,000 and 50,000 USD/Quality-Adjusted Life Year (QALY). Three-quarters of studies were financially supported, and in 90% of those, results were consistent with the funder’s interest. Economic evaluation of biologicals is crucial for responsible allocation of health care resources. In addition to summarizing the actual evidence this review highlights gaps and needs for future research.

Suggested Citation

  • Christian Kromer & Daniel Celis & Diana Sonntag & Wiebke K Peitsch, 2018. "Biologicals and small molecules in psoriasis: A systematic review of economic evaluations," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-22, January.
    • Handle: RePEc:plo:pone00:0189765
    DOI: 10.1371/journal.pone.0189765
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    References listed on IDEAS

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    1. Christopher Knight & Josephine Mauskopf & Mats Ekelund & Amitabh Singh & Shiyi Yang & Robert Boggs, 2012. "Cost-effectiveness of treatment with etanercept for psoriasis in Sweden," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(2), pages 145-156, April.
    2. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement," PharmacoEconomics, Springer, vol. 31(5), pages 361-367, May.
    3. Sabine I B Steinke & Wiebke K Peitsch & Alexander Ludwig & Matthias Goebeler, 2013. "Cost-of-Illness in Psoriasis: Comparing Inpatient and Outpatient Therapy," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-1, October.
    4. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    5. Reginald Villacorta & Joel Hay & Andrew Messali, 2013. "Cost Effectiveness of Moderate to Severe Psoriasis Therapy with Etanercept and Ustekinumab in the United States," PharmacoEconomics, Springer, vol. 31(9), pages 823-839, September.
    6. Wei Zhang & Nazrul Islam & Canice Ma & Aslam Anis, 2015. "Systematic Review of Cost-Effectiveness Analyses of Treatments for Psoriasis," PharmacoEconomics, Springer, vol. 33(4), pages 327-340, April.
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