Department of Health Outcomes Research, Weber, Madrid, Spain.
Department of Management, Psoriasis and Psoriatic Arthritis Patient and Family Association (Acción Psoriasis), Barcelona, Spain.
Front Public Health. 2023 Jan 26;11:1000776. doi: 10.3389/fpubh.2023.1000776. eCollection 2023.
INTRODUCTION: Psoriasis is a chronic disease involving the skin, which significantly impacts the quality of life. Disease severity and treatment efficacy (i.e., response) are assessed through the Psoriasis Area and Severity Index (PASI). A PASI 75 response, i.e., an improvement of at least 75% with respect to the baseline PASI score, has traditionally been used as a therapeutic benchmark in clinical trials. Therapeutic advances have made PASI 90 or PASI 100 responses possible in most patients treated with some biologics. A greater response may generate social value beyond clinical outcomes that would benefit both patients and society. METHODS: A 1-year economic model was applied to estimate the impact of having a PASI 75, PASI 90, or PASI 100 response in four areas of analysis (quality of life, activities of daily living, work productivity, and out-of-pocket expenditures) and the social value of having a PASI 90 or PASI 100 response in comparison with a PASI 75 response. A mixed-methods approach based on the scientific literature, a focus group with patient, and an advisory committee with psoriasis stakeholders was used. The model included three different scenarios: having a PASI 90 vs a PASI 75 response; a PASI 100 vs a PASI 90 response; and a PASI 100 vs a PASI 75 response. A sensitivity analysis was included. RESULTS: The annual economic impact per patient with moderate-to-severe plaque psoriasis having a PASI 75 response was estimated at Ł 6,139, mainly related to labour productivity losses and quality of life reductions. Having a PASI 90 or a PASI 100 response would reduce this impact to €3,956 or €1,353, respectively. Accordingly, the social value of having a PASI 90 instead of a PASI 75 response was estimated at €2,183, and €4,786 with a PASI 100 response. DISCUSSION: A PASI 90 or PASI 100 response would have a lower economic impact and a greater social value than a PASI 75 response for patients with moderate-to-severe plaque psoriasis.
引言:银屑病是一种涉及皮肤的慢性疾病,会显著影响生活质量。疾病严重程度和治疗效果(即反应)通过银屑病面积和严重程度指数(PASI)进行评估。传统上,PASI75 反应(即与基线 PASI 评分相比至少改善 75%)被用作临床试验中的治疗基准。随着治疗的进步,大多数接受某些生物制剂治疗的患者都有可能实现 PASI90 或 PASI100 反应。更大的反应可能会产生超出临床结果的社会效益,使患者和社会受益。
方法:应用了一种为期 1 年的经济模型,以评估在四个分析领域(生活质量、日常生活活动、工作生产力和自付支出)中达到 PASI75、PASI90 或 PASI100 反应的影响,以及与 PASI75 反应相比,达到 PASI90 或 PASI100 反应的社会效益。采用了一种基于科学文献、患者焦点小组和银屑病利益相关者咨询委员会的混合方法。该模型包括三种不同的情况:PASI90 与 PASI75 反应的比较;PASI100 与 PASI90 反应的比较;PASI100 与 PASI75 反应的比较。进行了敏感性分析。
结果:患有中度至重度斑块型银屑病且达到 PASI75 反应的患者,每年的经济影响估计为 6139 英镑,主要与劳动生产力损失和生活质量降低有关。达到 PASI90 或 PASI100 反应会将这种影响分别降低到 3956 欧元或 1353 欧元。因此,与 PASI75 反应相比,达到 PASI90 反应的社会效益估计为 2183 欧元,达到 PASI100 反应的社会效益估计为 4786 欧元。
讨论:与 PASI75 反应相比,患有中度至重度斑块型银屑病的患者达到 PASI90 或 PASI100 反应的经济影响较低,社会效益更大。