Service of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autónoma de Barcelona, Badalona, Barcelona, Spain.
J Eur Acad Dermatol Venereol. 2012 Jun;26(6):768-77. doi: 10.1111/j.1468-3083.2011.04357.x. Epub 2011 Nov 30.
Different biological agents are used for the treatment of psoriasis. Previous data have shown adalimumab to be the most efficient drug in terms of cost-efficacy. However, newer data are required to include recent drugs.
To estimate the cost-efficacy ratios of biological agents licensed in Spain (adalimumab, etanercept, infliximab and ustekinumab) for the treatment of patients with moderate-to-severe psoriasis.
An economic evaluation model was developed by building a decision tree for each drug regimen for which scientific evidence was available. The payer perspective (Spanish National Health System) was considered, taking into account only the drug costs. Data on efficacy [proportion of patients with a 75% reduction in the Psoriasis Area and Severity Index score (PASI 75)] reported in the randomized controlled trials were used. When more than one trial for each treatment had been published, a meta-analysis was performed. In case of weight-dependent doses (infliximab), weight of the study subjects was standardized by age and gender of the Spanish population, corrected for the increase in weight in subjects with psoriasis. Uncertainty was assessed by sensitivity analysis.
Incremental efficacy ranged from 31.19% (etanercept at a dosage of 25 mg twice a week for 12 weeks) to 78.35% (infliximab at 5 mg/kg for 24 weeks). Efficiency, in terms of incremental cost-efficacy, ranged from 8013€ (adalimumab) to 17 981€ (ustekinumab at a dose of 90 mg) per PASI 75 responder gained.
In terms of cost-efficacy, the most efficient biological drug was adalimumab. The robustness of this finding was confirmed by sensitivity analysis.
不同的生物制剂被用于治疗银屑病。先前的数据表明阿达木单抗在成本效益方面是最有效的药物。然而，需要新的数据来包括最近的药物。
评估在西班牙获得许可的生物制剂（阿达木单抗、依那西普、英夫利昔单抗和乌司奴单抗）治疗中重度银屑病患者的成本效益比。
为每种有科学证据的药物方案构建决策树，开发了一个经济评估模型。考虑到支付者视角（西班牙国家卫生系统），仅考虑药物成本。使用随机对照试验报告的疗效数据[达到银屑病面积和严重程度指数评分（PASI75）改善 75%的患者比例]。对于每种治疗方法，如果有多篇试验报告，将进行荟萃分析。对于依赖体重的剂量（英夫利昔单抗），将研究对象的体重根据西班牙人口的年龄和性别进行标准化，并校正银屑病患者体重的增加。通过敏感性分析评估不确定性。
增量疗效范围从 31.19%（依那西普每周 2 次、每次 25mg、共 12 周）到 78.35%（英夫利昔单抗每 24 周 5mg/kg）。从增量成本效益的角度来看，每获得一个 PASI75 应答者的效率范围从 8013 欧元（阿达木单抗）到 17981 欧元（乌司奴单抗剂量为 90mg）。
从成本效益的角度来看，最有效的生物药物是阿达木单抗。敏感性分析证实了这一发现的稳健性。
