Psoriasis Treatment in UK

 Recent study determined the cost-effectiveness of apremilast for the treatment of active psoriasis for adult patients who failed to respond to or are intoler-ant to disease-modifying antirheumatic drugs in UK. A Markov state-transition cohort model was adapted to the UK setting to compare costs and quality-adjusted life-years (QALYs) from 2 treatment sequences: apremilast, adali-mumab, etanercept, infliximab, and best supportive care (BSC) versus adalimumab, etanercept, infliximab, and BSC. The analysis time horizon was 40 years using a 28-day cycle length. The perspective of the UK National Health Service (NHS) was chosen. Treatment efficacy data (based on American College of Rheumatology [ACR] 20 criteria and Psoriasis Area and Severity Index [PASI] 50/75/90 response rates) were derived  from  a  network  meta-analysis  including  13  clinical  trials.  Resource  use  and unit costs were derived from Italian standard sources. 

 Frequency of screening and testing for each treatment was derived from real-world data. Utility weights associated with PASI states were derived from a published study. A 3% discount rate was applied to costs and benefits. Both deterministic and probabilistic sensitivity analyses (PSA) were performed. Results: In the base case, the sequence including apremilast resulted in an incremental cost per QALY gained of € 32,263.  Specifically, there was an increase of € 13,511  (€ 182,209  vs € 168,699) with an incremental gain of QALYs of 0.42 (9.57 vs 9.15) over 40 years. Base-case results were robust regarding changes in cost and efficacy data. Results were more sensitive to changes in utility weights, discount rates, and time horizon. The PSA confirmed that the apremilast sequence was cost-effective in the majority of the simulations at a willingness to pay  of  €  50,000  per  QALY.  This  analysis  suggests  that  the  use  of  apremilast for the treatment of psoriatic arthritis may represent a cost-effective option for the psoriasis patients in UK. (Read more : What Is The Best Way to Get Rid of Psoriasis ? )