Colombo Giorgio L, Di Matteo Sergio, Peris Ketty, Fargnoli Maria Concetta, Esposito Maria, Mazzotta Annamaria, Chimenti Sergio
Faculty of Pharmacy, University of Pavia, Pavia, Italy;
Clinicoecon Outcomes Res. 2009;1:53-9. doi: 10.2147/ceor.s7348. Epub 2009 Oct 15.
Biologic therapies have proven efficacious for patients with moderate-to-severe psoriasis. However, their economic value compared with standard of care in Italy has not been explored. This study estimates the cost-effectiveness of intermittent therapy with etanercept in patients with moderate-to-severe plaque-type psoriasis in comparison with nonsystemic therapy in Italy.
This study employs cost-utility analysis using a Markov model adapted from the British "York model". It compares the cost per quality-adjusted life-year (QALY) of intermittent etanercept (25 mg twice weekly) versus nonsystemic therapy. Data on efficacy and changes in quality of life were derived from three etanercept clinical trials. Direct costs of treating psoriasis patients, including hospitalizations and dermatology clinic visits, were taken from an Italian cost-of-illness study. Extrapolations were made to evaluate the cost-effectiveness of intermittent etanercept versus nonsystemic therapy over a period of ten years.
For the group of patients with moderate and severe plaque psoriasis (initial Psoriasis Area and Severity Index [PASI ≥ 10]) the incremental cost-effectiveness ratio (ICER) for etanercept compared with nonsystemic therapy was €33,216/QALY; for the group of patients with severe psoriasis (PASI ≥ 20), the ICER was €25,486/QALY.
Within the Italian health care system, intermittent etanercept is a cost-effective therapeutic option compared with nonsystemic therapy for the group of patients with moderate and severe plaque psoriasis. For patients with PASI ≥ 20, cost-effectiveness of etanercept is even greater.
生物疗法已被证明对中重度银屑病患者有效。然而，与意大利的标准治疗相比，其经济价值尚未得到探讨。本研究评估了与意大利的非系统性治疗相比，依那西普间歇疗法治疗中重度斑块型银屑病患者的成本效益。
本研究采用成本效用分析，使用了一个改编自英国“约克模型”的马尔可夫模型。它比较了间歇使用依那西普（每周两次，每次25毫克）与非系统性治疗的每质量调整生命年（QALY）成本。疗效和生活质量变化的数据来自三项依那西普临床试验。治疗银屑病患者的直接成本，包括住院和皮肤科门诊就诊，取自一项意大利疾病成本研究。进行外推以评估间歇使用依那西普与非系统性治疗在十年期间的成本效益。
对于中重度斑块状银屑病患者组（初始银屑病面积和严重程度指数[PASI≥10]），依那西普与非系统性治疗相比的增量成本效益比（ICER）为33,216欧元/QALY；对于重度银屑病患者组（PASI≥20），ICER为25,486欧元/QALY。
在意大利医疗保健系统内，与非系统性治疗相比，间歇使用依那西普对于中重度斑块状银屑病患者组是一种具有成本效益的治疗选择。对于PASI≥20的患者，依那西普的成本效益更高。
