Armstrong April W, Betts Keith A, Signorovitch James E, Sundaram Murali, Li Junlong, Ganguli Arijit X, Wu Eric Q
a Keck School of Medicine , University of Southern California , Los Angeles , CA , USA.
b Analysis Group, Inc. , Boston , MA , USA.
Curr Med Res Opin. 2018 Jul;34(7):1325-1333. doi: 10.1080/03007995.2018.1457516. Epub 2018 Apr 23.
The clinical benefits of biologic therapies for moderate-to-severe psoriasis are well established, but wide variations exist in patient response.
To determine the number needed to treat (NNT) to achieve a 75% and 90% reduction in the Psoriasis Area and Severity Index (PASI-75/90) with FDA-approved agents and evaluate the incremental cost per PASI-75 or PASI-90 responder.
The relative probabilities of achieving PASI-75 and PASI-90, as well as NNTs, were estimated using a network meta-analysis. Costs (2017 USD) included drug acquisition and administration. The incremental cost per PASI-75 or PASI-90 responder for each treatment was estimated for the clinical trial period, and annually.
Compared with supportive care, the NNT to achieve PASI-75 was 1.18 for ixekizumab, 1.29 for secukinumab 300 mg, 1.37 for infliximab, 1.48 for adalimumab, 1.53 for secukinumab 150 mg, 1.58 for ustekinumab, 2.25 for etanercept, and 3.71 for apremilast. The one-year incremental cost per PASI-75 responder relative to supportive care was $59,830 for infliximab, $88,775 for secukinumab 300 mg, $91,837 for adalimumab, $95,898 for ixekizumab, $97,363 for ustekinumab, $105,131 for secukinumab 150 mg, $129,665 for apremilast, and $159,328 for etanercept. Results were similar for PASI-90.
The NNT and incremental cost per responder are meaningful ways to assess comparative effectiveness and cost effectiveness among psoriasis treatments.
生物疗法对中重度银屑病的临床益处已得到充分证实，但患者反应存在很大差异。
确定使用美国食品药品监督管理局（FDA）批准的药物使银屑病面积和严重程度指数（PASI - 75/90）降低75%和90%所需的治疗人数（NNT），并评估每例达到PASI - 75或PASI - 90反应者的增量成本。
使用网络荟萃分析估计达到PASI - 75和PASI - 90的相对概率以及NNT。成本（2017年美元）包括药物采购和给药。估计每种治疗在临床试验期间及每年每例达到PASI - 75或PASI - 90反应者的增量成本。
与支持性治疗相比，达到PASI - 75的NNT，依奇珠单抗为1.18，300mg司库奇尤单抗为1.29，英夫利昔单抗为1.37，阿达木单抗为1.48，150mg司库奇尤单抗为1.53，乌司奴单抗为1.58，依那西普为2.25，阿普斯特为3.71。相对于支持性治疗，每例达到PASI - 75反应者的一年增量成本，英夫利昔单抗为59,830美元，300mg司库奇尤单抗为88,775美元，阿达木单抗为91,837美元，依奇珠单抗为95,898美元，乌司奴单抗为97,363美元，150mg司库奇尤单抗为105,131美元，阿普斯特为129,665美元，依那西普为159,328美元。PASI - 90的结果相似。
NNT和每例反应者的增量成本是评估银屑病治疗之间比较有效性和成本效益的有意义方法。
