Symmetron Limited, Kinetic Centre, Theobald Street, Borehamwood, Hertfordshire, WD6 4PJ, UK.
Br J Dermatol. 2013 May;168(5):1095-105. doi: 10.1111/bjd.12261.
Topical therapies are a mainstay of psoriasis treatment, but they vary substantially in terms of cost.
To determine the cost-effectiveness and optimal treatment sequence for psoriasis of the trunk, limbs and scalp.
Probabilities of response from a network meta-analysis were used to determine the short-term efficacy of topical therapies. Longer-term outcomes, including relapse, were informed by published evidence and clinical opinion. Benefits of treatment were measured as quality-adjusted life years (QALYs). Direct costs included topical agents, primary and secondary care visits and second-line therapies for treatment failures.
For the trunk and limbs, initial treatment with a two-compound formulation (TCF) product containing vitamin D and potent corticosteroid provided the most QALYs, followed by separate morning and evening application of vitamin D and potent corticosteroid [two-compound application, TCA (am/pm)], and then twice-daily potent corticosteroids. The use of twice-daily potent corticosteroids was the most cost-effective first-line strategy (incremental cost-effectiveness ratio £ 20,000 per QALY), followed by TCA (am/pm) (£ 22,658 per QALY) and TCF product (£ 179,439 per QALY). For scalp psoriasis, initial treatment with very potent corticosteroids generated the most QALYs, followed by TCF product and then potent corticosteroids. Very potent corticosteroids were the most cost-effective treatment but, if too aggressive, potent corticosteroids were optimal followed by TCF product (£ 219,846 per QALY). The cost-effectiveness of second- and third-line topical agents varied with the assumptions made.
Potent corticosteroids, used alone or in combination with vitamin D, are the most cost-effective treatment for patients with psoriasis of the trunk and limbs. Potent or very potent corticosteroids are the most cost-effective treatment for patients with scalp psoriasis.
局部治疗是银屑病治疗的主要方法，但它们在成本方面有很大的差异。
确定躯干、四肢和头皮银屑病的成本效益和最佳治疗顺序。
使用网络荟萃分析的反应概率来确定局部治疗的短期疗效。更长时间的结果，包括复发，由已发表的证据和临床意见告知。治疗的益处以质量调整生命年（QALY）衡量。直接成本包括局部药物、初级和二级护理就诊以及二线治疗失败的治疗。
对于躯干和四肢，最初使用含有维生素 D 和强效皮质类固醇的双化合物制剂（TCF）产品提供了最多的 QALYs，其次是维生素 D 和强效皮质类固醇的早晚分开应用（TCF 应用，TCA（am/pm）），然后是每日两次强效皮质类固醇。每日两次使用强效皮质类固醇是最具成本效益的一线策略（增量成本效益比为每 QALY20,000 英镑），其次是 TCA（am/pm）（每 QALY22,658 英镑）和 TCF 产品（每 QALY179,439 英镑）。对于头皮银屑病，最初使用超强效皮质类固醇产生了最多的 QALYs，其次是 TCF 产品，然后是强效皮质类固醇。超强效皮质类固醇是最具成本效益的治疗方法，但如果过于激进，强效皮质类固醇是最佳选择，其次是 TCF 产品（每 QALY219,846 英镑）。二线和三线局部药物的成本效益因假设而异。
单独使用或与维生素 D 联合使用的强效皮质类固醇是躯干和四肢银屑病患者最具成本效益的治疗方法。强效或超强效皮质类固醇是头皮银屑病患者最具成本效益的治疗方法。
