St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK.
York Health Economics Consortium, York, UK.
Clin Drug Investig. 2021 Nov;41(11):1011-1020. doi: 10.1007/s40261-021-01089-4. Epub 2021 Oct 16.
There is limited guidance on which biologic therapies should be prioritised for the treatment of moderate-to-severe psoriasis, amongst the many available options. New mode-of-action biologics, as well as recently available biosimilars for existing biologics, continue to be developed making the choice of treatment sequence increasingly complex.
The aim of this analysis was to develop a cost-effectiveness model to determine the optimal placement of biologic therapies on the treatment pathway for psoriasis in the UK.
A cohort-based Markov model was developed in Microsoft Excel, from the perspective of the National Health Service and Personal and Social Services in the UK. The model followed a hypothetical cohort of patients over a lifetime. The health states in the model were defined by Psoriasis Area and Severity Index response. In the model, patients could receive a total of four separate treatments, including three active interventions and best supportive care.
A fully incremental analysis was undertaken on a subset of commonly used treatment sequences. The results of the list price analyses determined the most cost-effective sequence to be adalimumab biosimilar followed by ustekinumab, secukinumab, then best supportive care. This sequence is associated with total costs of £78,731 and total quality-adjusted life-years of 14.74 over a patient's lifetime.
This research suggests that the optimal first-line treatment in the UK is adalimumab biosimilar. The optimal second-line and third-line treatments depend on the magnitude of confidential discounts applied to the biologic treatments.
在众多可用的选择中，对于中度至重度银屑病的治疗，哪种生物疗法应该优先，这方面的指导有限。新的作用机制生物制剂以及现有生物制剂的最近可用生物仿制药不断被开发出来，使得治疗顺序的选择变得越来越复杂。
本分析旨在开发一种成本效益模型，以确定英国银屑病治疗途径中生物疗法的最佳定位。
在 Microsoft Excel 中开发了基于队列的马尔可夫模型，从英国国民保健制度和个人及社会服务的角度出发。该模型在一生中跟踪一个假设的患者队列。模型中的健康状态由银屑病面积和严重程度指数反应定义。在模型中，患者可以接受总共四种单独的治疗，包括三种活性干预措施和最佳支持性护理。
对常用治疗序列的子集进行了完全增量分析。定价分析的结果确定了最具成本效益的序列，即阿达木单抗生物类似物，其次是乌司奴单抗、司库奇尤单抗，然后是最佳支持性护理。在患者的一生中，该序列与总成本为 78731 英镑和总质量调整生命年 14.74 相关。
这项研究表明，阿达木单抗生物类似物是英国的最佳一线治疗药物。最佳二线和三线治疗取决于对生物治疗应用的保密折扣的幅度。
