Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Faculty of Business and Management, Universiti Teknologi MARA Puncak Alam Campus, Selangor, Malaysia.
PLoS One. 2024 Sep 6;19(9):e0307234. doi: 10.1371/journal.pone.0307234. eCollection 2024.
In Malaysia, there is now a dearth of recommendations pertaining to the priority of biologic treatments for the effective management of psoriasis, given the multitude of available therapeutic alternatives. Present analysis reports results of a cost-effectiveness model that determines the most optimal arrangement of biologic treatments, with a particular focus of adding biosimilars to the existing treatment pathway for psoriasis in Malaysia.
A Markov model was developed to compare the cost effectiveness of various biologic sequential treatments in a hypothetical cohort of moderate to severe psoriasis patient in Malaysia over a lifetime horizon. The model simulated the progression of patients through three lines of active biologic therapy, before transitioning to best supportive care. Costs and effects were discounted annually at a rate of 3%.
First line secukinumab has produced lowest incremental cost effectiveness ratios (ICERs) when compared to first line systemic [ICERs value; US$152,474 (first set analysis) and US$110,572 (second set analysis)] and first line phototherapy [ICERs value; US$147,057 (first set analysis) and US$107,616 (second set analysis)]. However, these values were slightly higher than the Malaysian based threshold of three times gross domestic product per capita, US$104,337. A 40% reduction in the unit costs of reference biologics renders most of the evaluated treatment sequences cost-effective.
Adding biosimilar to the current treatment sequence could achieve cost savings ranging from 4.3% to 10.8% without significant loss of effectiveness. Given the significant impact of comorbidities and the resulting decline in quality of life among individuals with psoriasis, it may be justifiable to establish a threshold of up to US$184,000 per quality-adjusted life year (QALY) for the provision of therapies in the context of Malaysia.
在马来西亚，由于有多种治疗选择，针对有效管理银屑病的生物治疗优先级，目前缺乏相关建议。本分析报告介绍了一个成本效益模型的结果，该模型确定了生物治疗的最佳安排，特别关注在马来西亚现有的银屑病治疗途径中添加生物仿制药。
为了在马来西亚一个中度至重度银屑病患者的假设队列中，在一生中的时间范围内比较各种生物序贯治疗的成本效益，我们开发了一个马尔可夫模型。该模型模拟了患者在接受三种有效的生物治疗方案后过渡到最佳支持治疗的进展情况。成本和效果每年按 3%的贴现率贴现。
与一线系统性治疗（ICER 值：首次分析为 152474 美元，第二次分析为 110572 美元）和一线光疗（ICER 值：首次分析为 147057 美元，第二次分析为 107616 美元）相比，一线司库珠单抗产生了最低的增量成本效益比（ICERs）。然而，这些值略高于马来西亚基于人均国民生产总值三倍的阈值，即 104337 美元。参考生物制剂单位成本降低 40%，使大多数评估的治疗方案具有成本效益。
在不显著降低疗效的情况下，将生物仿制药添加到当前的治疗方案中可以节省 4.3%至 10.8%的成本。鉴于银屑病患者的合并症和生活质量下降带来的显著影响，在马来西亚，为提供治疗而建立高达 184000 美元/质量调整生命年（QALY）的阈值可能是合理的。
