Imafuku Shinichi, Nakano Ataru, Dakeshita Hidetoshi, Li Junlong, Betts Keith A, Guerin Annie
a Department of Dermatology , Fukuoka University , Fukuoka , Japan.
b Market Access Value Proposition, Market Access & External Relations , AbbVie GK , Tokyo , Japan.
J Dermatolog Treat. 2018 Feb;29(1):24-31. doi: 10.1080/09546634.2017.1341607. Epub 2017 Jun 23.
Biologics have been shown to improve the outcomes of patients with psoriasis but their cost is an issue.
Determine the number needed to treat (NNT) to achieve a 75%/90% reduction in the Psoriasis Area and Severity Index (PASI-75/90) and evaluate the incremental cost per PASI-75/90 responder (CPR) relative to placebo in Japan.
A network meta-analysis was conducted to estimate the relative probabilities of achieving PASI-75/90 and NNTs. Drug costs were assessed based on Pharmaceutical and Medical Device Agency-approved dosing. The CPR was estimated for a short-term induction period and first year of treatment.
Compared with placebo, the PASI-75 NNT was 1.27 for adalimumab 80 mg, 1.29 for secukinumab 150 mg, 1.36 for secukinumab 300 mg, 1.57 for adalimumab 40 mg, 1.68 for ustekinumab 90 mg, 1.97 for ustekinumab 45 mg and 2.00 for infliximab 5 mg/kg. The short-term PASI-75 CPR relative to placebo was $5,062 for secukinumab 150 mg, $8209 for adalimumab 40 mg, $10,654 for secukinumab 300 mg, $11,754 for adalimumab 80 mg, $15,407 for ustekinumab 45 mg, $19,147 for infliximab 5 mg/kg and $26,257 for ustekinumab 90 mg. A similar ranking was observed for one-year PASI-75 CPRs and PASI-90 NNTs and CPRs.
Adalimumab 40 mg/80 mg and secukinumab 150 mg/300 mg were the most efficacious and cost-efficient for patients with psoriasis in Japan.
生物制剂已被证明可改善银屑病患者的治疗效果，但其成本是一个问题。
确定实现银屑病面积和严重程度指数（PASI - 75/90）降低75%/90%所需的治疗人数（NNT），并评估在日本相对于安慰剂的每例PASI - 75/90缓解者的增量成本（CPR）。
进行网络荟萃分析以估计实现PASI - 75/90的相对概率和NNT。根据药品和医疗器械局批准的剂量评估药物成本。对短期诱导期和治疗的第一年估计CPR。
与安慰剂相比，阿达木单抗80mg的PASI - 75 NNT为1.27，司库奇尤单抗150mg为1.29，司库奇尤单抗300mg为1.36，阿达木单抗40mg为1.57，乌司奴单抗90mg为1.68，乌司奴单抗45mg为1.97，英夫利昔单抗5mg/kg为2.00。相对于安慰剂，司库奇尤单抗150mg的短期PASI - 75 CPR为5062美元，阿达木单抗40mg为8209美元，司库奇尤单抗300mg为10654美元，阿达木单抗80mg为11754美元，乌司奴单抗45mg为15407美元，英夫利昔单抗5mg/kg为19147美元，乌司奴单抗90mg为26257美元。在一年期PASI - 75 CPR以及PASI - 90 NNT和CPR方面观察到类似的排名。
在日本，40mg/80mg的阿达木单抗和150mg/300mg的司库奇尤单抗对银屑病患者最有效且最具成本效益。
