Chen S, Shaheen A, Garber A
Department of Dermatology, Stanford University, Calif., USA.
Arch Dermatol. 1998 Dec;134(12):1602-8. doi: 10.1001/archderm.134.12.1602.
To analyze the net benefit and cost-effectiveness of methotrexate use and Goeckerman therapy for psoriasis.
Net benefit and cost-effectiveness depend on the costs, efficacy, and utilities of therapy. Utilities are quantitative measures of patient preferences. We obtained costs by using resource-based accounting techniques. Efficacy was estimated from literature reports. We surveyed patients with psoriasis, dermatologists, and healthy subjects using utility assessment methods. All assumptions were examined in a sensitivity analysis.
For net benefit, if benefits out-weighed the costs, it was deemed worth providing. For the cost-effectiveness analysis, the ratio of costs-to-effectiveness of less than $35,000 was considered cost-effective.
Using utilities from healthy nonexperts, the costs of both therapies exceeded the benefits in mild and moderate psoriasis. In severe psoriasis, only methotrexate demonstrates a net benefit. Both therapies were cost-effective compared with no therapy. Liquid methotrexate should be chosen over the tablet form since it was cheaper and had the same outcome. Goeckerman was cost-effective against liquid methotrexate in severe, but not mild or moderate psoriasis. There was a trend for therapies to be more cost-effective when using patient utilities and less with dermatologist utilities. The results were highly sensitive to efficacy and utilities.
The results of this study need to be confirmed in other settings, but they demonstrate that the tools of cost-effectiveness and cost-benefit analysis have great potential value in dermatology. Once efficacy is better characterized and utilities better quantified, these types of analyses will be crucial for health care policy.
分析甲氨蝶呤治疗和格克曼疗法治疗银屑病的净效益及成本效益。
净效益和成本效益取决于治疗的成本、疗效及效用。效用是对患者偏好的定量衡量。我们采用基于资源的核算技术获取成本。疗效根据文献报告估算。我们使用效用评估方法对银屑病患者、皮肤科医生和健康受试者进行了调查。所有假设均在敏感性分析中进行了检验。
对于净效益，如果效益超过成本，则认为值得提供。对于成本效益分析，成本效益比低于35,000美元被认为具有成本效益。
采用非专业健康人群的效用数据时，在轻度和中度银屑病中，两种疗法的成本均超过效益。在重度银屑病中，只有甲氨蝶呤显示出净效益。与不治疗相比，两种疗法均具有成本效益。应选择液体制剂而非片剂甲氨蝶呤，因为其成本更低且疗效相同。在重度而非轻度或中度银屑病中，格克曼疗法相对于液体制剂甲氨蝶呤具有成本效益。当使用患者效用数据时，疗法往往更具成本效益，而使用皮肤科医生效用数据时则不然。结果对疗效和效用高度敏感。
本研究结果需要在其他环境中得到证实，但它们表明成本效益分析和成本效益分析工具在皮肤病学中具有巨大的潜在价值。一旦疗效得到更好的描述且效用得到更好的量化，这类分析对于医疗保健政策将至关重要。
