de Argila D, Rodríguez-Nevado I, Chaves A
Unidad de Dermatología, Hospital Universitario Infanta Cristina, Badajoz, España.
Actas Dermosifiliogr. 2007 Jan-Feb;98(1):35-41.
To perform a cost-effectiveness analysis, by using a decision tree model, comparing methotrexate with PUVA therapy for moderate to severe chronic plaque psoriasis in the sanitary area of Badajoz (south-western Spain) over a one-year period.
The following variables and data sources were included: efficacy (a 50 % reduction in the PASI) and safety (adverse reactions). Data were retrieved from the dermatologic medical literature, mainly general reviews, systematic reviews and randomized clinical trials. Therapy schedules followed current guidelines from work task teams and consensus documents. Direct costs included unitary costs of medical consults, costs of laboratory tests, pharmacy, phototherapy sessions and costs derived from adverse reactions. Indirect costs included travel expenses and costs of lost productive work time.
Unitary cost of methotrexate therapy would be 952.79 euros per treatment (direct cost: 796.48; indirect cost: 156.31). Unitary cost of PUVA therapy would be 899.70 euros per treatment (direct cost: 383.36; indirect cost: 516.34). Total cost of a one-year treatment with methotrexate would be 255,202.73 euros. Total cost of a one-year treatment with PUVA would be 266,406.88 euros. The average cost-effectiveness ratios per case effectively treated would be 1,519.06 euros for methotrexate therapy, and 1,085.18 euros for PUVA therapy. The incremental cost-effectiveness ratio of PUVA/methotrexate would be 150.65 euros for each additional case effectively treated.
One-year treatment for moderate to severe psoriasis in the sanitary area of Badajoz would be more expensive but also more cost-effective with PUVA than with methotrexate. However, indirect costs (borne by patients), are higher for PUVA therapy, a fact that raises an issue of equity. The results should be interpreted taking into account the methodological limitations of a modelling study.
通过决策树模型进行成本效益分析，比较甲氨蝶呤与补骨脂素紫外线A光化学疗法（PUVA）对巴达霍斯卫生区（西班牙西南部）中度至重度慢性斑块状银屑病患者进行为期一年治疗的效果。
纳入以下变量和数据来源：疗效（银屑病面积和严重程度指数[PASI]降低50%）和安全性（不良反应）。数据取自皮肤病医学文献，主要是综述、系统评价和随机临床试验。治疗方案遵循工作任务小组的现行指南和共识文件。直接成本包括医疗咨询的单位成本、实验室检查成本、药房成本、光疗疗程成本以及不良反应产生的成本。间接成本包括差旅费和生产性工作时间损失成本。
甲氨蝶呤治疗的单位成本为每次治疗952.79欧元（直接成本：796.48欧元；间接成本：156.31欧元）。PUVA治疗的单位成本为每次治疗899.70欧元（直接成本：383.36欧元；间接成本：516.34欧元）。甲氨蝶呤一年治疗的总成本为255,202.73欧元。PUVA一年治疗的总成本为266,406.88欧元。甲氨蝶呤治疗每例有效治疗病例的平均成本效益比为1,519.06欧元，PUVA治疗为1,085.18欧元。PUVA/甲氨蝶呤的增量成本效益比为每多治疗一例有效病例150.65欧元。
在巴达霍斯卫生区，对中度至重度银屑病进行一年治疗，PUVA治疗比甲氨蝶呤治疗成本更高，但成本效益也更高。然而，PUVA治疗的间接成本（由患者承担）更高，这一事实引发了公平性问题。应考虑到建模研究的方法学局限性来解释这些结果。
