Opmeer Brent C, Heydendael Vera M R, De Borgie Corianne A J M, Spuls Phyllis I, Bossuyt Patrick M M, Bos Jan D, De Rie Menno A
Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands.
Arch Dermatol. 2004 Jun;140(6):685-90. doi: 10.1001/archderm.140.6.685.
To document and compare the costs of treatment of psoriasis with 2 established systemic agents that differ substantially in their unit costs: methotrexate vs cyclosporine.
Cost-minimization analysis within a randomized controlled trial.
Outpatient dermatology department at an academic hospital.
Adults with moderate to severe plaque psoriasis, with no previous methotrexate or cyclosporine treatment.
Sixteen weeks of treatment with methotrexate or cyclosporine and an additional 36 weeks of follow-up.
Direct and indirect medical and nonmedical costs associated with resource utilization during treatment and follow-up.
Average cumulative total costs associated with 16 weeks of treatment were 1593 US dollars for methotrexate and 2114 US dollars for cyclosporine (521 US dollars less for methotrexate); during 36 weeks of follow-up, these costs were 2418 US dollars and 2306 US dollars, respectively. The overall difference in cumulative 1-year costs was 409 US dollars, or approximately 10% of the total costs.
After 1 year, the overall difference in total costs between methotrexate and cyclosporine for 16 weeks of treatment and follow-up is relatively small. Systemic medication costs are only a fraction of the costs directly and indirectly generated by utilization of health care resources and associated with individual patients rather than with methotrexate or cyclosporine. Economic arguments can be supportive of but not decisive for individual patient decisions and guidelines for systemic therapy. Rational decision making for the treatment of psoriasis may include costs only within a long-term horizon and may consider the societal and patient benefits of different alternatives.
记录并比较两种已确立的全身用药治疗银屑病的成本，这两种药物的单位成本差异很大：甲氨蝶呤与环孢素。
随机对照试验中的成本最小化分析。
一所学术医院的门诊皮肤科。
中度至重度斑块状银屑病成人患者，既往未接受过甲氨蝶呤或环孢素治疗。
甲氨蝶呤或环孢素治疗16周，并额外随访36周。
治疗和随访期间与资源利用相关的直接和间接医疗及非医疗成本。
与16周治疗相关的平均累计总成本，甲氨蝶呤为1593美元，环孢素为2114美元（甲氨蝶呤少521美元）；在36周的随访期间，这些成本分别为2418美元和2306美元。1年累计成本的总体差异为409美元，约占总成本的10%。
1年后，甲氨蝶呤和环孢素在16周治疗及随访后的总成本总体差异相对较小。全身用药成本仅占医疗保健资源利用直接和间接产生的、与个体患者而非甲氨蝶呤或环孢素相关成本的一小部分。经济因素可支持但不能决定个体患者的决策及全身治疗指南。银屑病治疗的合理决策可能仅在长期范围内考虑成本，并可能考虑不同治疗方案的社会和患者获益。
