Sun Helen Y, Keller Elena, Suresh Harish, Sebaratnam Deshan F
Faculty of Medicine and Health, The University of New South Wales, Kensington, New South Wales, Australia.
Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia.
JAAD Int. 2021 Aug 9;5:1-8. doi: 10.1016/j.jdin.2021.06.004. eCollection 2021 Dec.
Biologics are a good therapeutic option for severe, chronic plaque psoriasis; however, they come with significant cost to the health care system.
To conduct a cost-utility analysis of outpatient biologics (adalimumab, etanercept, guselkumab, ixekizumab, risankizumab, secukinumab, tildrakizumab, and ustekinumab) available to adults with severe, chronic plaque psoriasis from the perspective of the Australian health care system.
A Markov cohort model was constructed to estimate the quality-adjusted life years (QALYs) and costs accrued for treatment pathways commencing with different first-line biologics, over a 96-week time horizon. The model adhered to the Australian Pharmaceutical Benefits Scheme eligibility criteria and guidelines.
A biologic treatment pathway commencing on tildrakizumab was the most cost-effective first-line treatment (Australian dollar 39,930; total utility of 1.57 QALYs over 96 weeks). First-line secukinumab and risankizumab had incremental cost-utility ratios of Australian dollar 194,524/QALY and Australian dollar 479,834/QALY, respectively, when compared with first-line tildrakizumab.
The efficacy and utility input parameters were derived from international randomized control trials and patients from the United Kingdom, respectively. Findings from this study cannot be generalized beyond Australia.
Tildrakizumab may be considered as first-line treatment for adult patients with severe, chronic plaque psoriasis embarking on biologic therapy, from the economic perspective of the Australian health care system.
生物制剂是重度慢性斑块状银屑病的一种良好治疗选择；然而，它们给医疗保健系统带来了巨大成本。
从澳大利亚医疗保健系统的角度，对重度慢性斑块状银屑病成人患者可用的门诊生物制剂（阿达木单抗、依那西普、古塞库单抗、司库奇尤单抗、瑞莎珠单抗、塞克硝唑、替拉珠单抗和乌司奴单抗）进行成本效用分析。
构建一个马尔可夫队列模型，以估计从不同一线生物制剂开始治疗的治疗途径在96周时间范围内产生的质量调整生命年（QALY）和成本。该模型符合澳大利亚药品福利计划的资格标准和指南。
以替拉珠单抗开始的生物治疗途径是最具成本效益的一线治疗（39,930澳元；96周内总效用为1.57个QALY）。与一线替拉珠单抗相比，一线司库奇尤单抗和瑞莎珠单抗的增量成本效用比分别为194,524澳元/QALY和479,834澳元/QALY。
疗效和效用输入参数分别来自国际随机对照试验和英国患者。本研究结果不能推广到澳大利亚以外的地区。
从澳大利亚医疗保健系统的经济角度来看，对于开始生物治疗的重度慢性斑块状银屑病成年患者，替拉珠单抗可被视为一线治疗药物。
