Udkoff Jeremy, Eichenfield Lawrence F
J Drugs Dermatol. 2017 Oct 1;16(10):964-970.
Biologic therapies have revolutionized the treatment of psoriasis; however, their use is limited by costs. Ixekizumab was more effective than etanercept in the UNCOVER trials, and the Food and Drug Administration (FDA) approved ixekizumab for treating psoriasis. Evaluating the cost-effectiveness of these therapies is crucial for medical decision making and our objective was to determine the cost-effectiveness of various ixekizumab dosing frequencies compared with etanercept.
We utilized published data from the UNCOVER comparative efficacy trials, including transitional probabilities and treatment response rates, to create a Markov model simulating the clinical course and cost-effectiveness of three treatment algorithms for patients with moderate to severe plaque psoriasis over 60-weeks: (1) ixekizumab every 2 weeks for 12 weeks then every 4 weeks, (2) ixekizumab every 4 weeks throughout the treatment period, (3) biweekly etanercept for 12 weeks then once weekly. We utilized a standard willingness-to-pay (WTP) threshold of $150,000 per quality adjusted life year (QALY) and Medicaid drug acquisition costs for our calculations.
Ixekizumab every 4 weeks was $28,681 (USD) less expensive than biweekly etanercept, and $21,375 less expensive, and 0.006 QALY less effective, than ixekizumab every 2 weeks-- a savings of $28.7 and $21.4 million, respectively, per 1,000 patients. A 95.6% cost reduction to $197.83 per dose is required for ixekizumab every 2 weeks to be more cost-effective than every 4 weeks. Biweekly etanercept requires a 29.5% cost reduction ($743.82 per dose) to be competitive with ixekizumab every 4 weeks.
This cost-effectiveness model utilizes strong input data but is a limited approximation of real-life scenarios. Treatment with ixekizumab every 2 weeks is unlikely to be cost-effective compared with ixekizumab every 4 weeks at current U.S. market prices. Yet, the U.S. FDA approval and manufacturer's recommendation are for ixekizumab every 2 weeks. Accordingly, we suggested selecting biologic therapies using cost-effectiveness analyses.
J Drugs Dermatol. 2017;16(10):964-970.
.生物疗法彻底改变了银屑病的治疗方式；然而，其应用受到成本的限制。在“揭示”试验中，司库奇尤单抗比依那西普更有效，美国食品药品监督管理局（FDA）批准司库奇尤单抗用于治疗银屑病。评估这些疗法的成本效益对于医疗决策至关重要，我们的目标是确定与依那西普相比，司库奇尤单抗不同给药频率的成本效益。
我们利用“揭示”比较疗效试验中已发表的数据，包括转移概率和治疗反应率，建立了一个马尔可夫模型，模拟中度至重度斑块状银屑病患者在60周内三种治疗方案的临床过程和成本效益：（1）司库奇尤单抗每2周一次，共12周，然后每4周一次；（2）司库奇尤单抗在整个治疗期间每4周一次；（3）依那西普每2周一次，共12周，然后每周一次。我们使用每质量调整生命年（QALY）150,000美元的标准支付意愿（WTP）阈值和医疗补助药物采购成本进行计算。
司库奇尤单抗每4周一次的成本比依那西普每2周一次低28,681美元（美元），比司库奇尤单抗每2周一次低21,375美元，且效果少0.006 QALY——每1000名患者分别节省2870万美元和2140万美元。司库奇尤单抗每2周一次要比每4周一次更具成本效益，每剂成本需降低95.6%至197.83美元。依那西普每2周一次要与司库奇尤单抗每4周一次竞争，成本需降低29.5%（每剂743.82美元）。
这个成本效益模型使用了有力的输入数据，但只是对现实场景的有限近似。在美国当前市场价格下，司库奇尤单抗每2周一次的治疗与每4周一次相比不太可能具有成本效益。然而，美国FDA的批准和制造商的推荐是司库奇尤单抗每2周一次。因此，我们建议使用成本效益分析来选择生物疗法。
《皮肤药物学杂志》。2017年；16(10):964 - 970。
