Funding sources National Institute for Health and Clinical Excellence and National Institute for Health Research comprehensive Biomedical Research Centre.
Topical therapies for the treatment of localized plaque psoriasis in primary care: a cost-effectiveness analysis
Version of Record online: 25 APR 2013
© 2013 The Authors BJD © 2013 British Association of Dermatologists
British Journal of Dermatology
Volume 168, Issue 5, pages 1095–1105, May 2013
How to Cite
Sawyer, L., Samarasekera, E.J., Wonderling, D. and Smith, C.H. (2013), Topical therapies for the treatment of localized plaque psoriasis in primary care: a cost-effectiveness analysis. British Journal of Dermatology, 168: 1095–1105. doi: 10.1111/bjd.12261
Conflicts of interest All authors were members of the National Institute for Health and Clinical Excellence Psoriasis Guideline Development Group (C.H.S. chaired the group, L.S. and D.W. were the health economists and E.J.S. was the research fellow). After completing the guideline analysis but before its publication, L.S. joined Symmetron Limited.
- Issue online: 25 APR 2013
- Version of Record online: 25 APR 2013
- Accepted manuscript online: 3 FEB 2013 09:34PM EST
- Manuscript Accepted: 27 JAN 2013
- National Institute for Health and Clinical Excellence
- National Institute for Health Research comprehensive Biomedical Research Centre
Topical therapies are a mainstay of psoriasis treatment, but they vary substantially in terms of cost.
To determine the cost-effectiveness and optimal treatment sequence for psoriasis of the trunk, limbs and scalp.
Probabilities of response from a network meta-analysis were used to determine the short-term efficacy of topical therapies. Longer-term outcomes, including relapse, were informed by published evidence and clinical opinion. Benefits of treatment were measured as quality-adjusted life years (QALYs). Direct costs included topical agents, primary and secondary care visits and second-line therapies for treatment failures.
For the trunk and limbs, initial treatment with a two-compound formulation (TCF) product containing vitamin D and potent corticosteroid provided the most QALYs, followed by separate morning and evening application of vitamin D and potent corticosteroid [two-compound application, TCA (am/pm)], and then twice-daily potent corticosteroids. The use of twice-daily potent corticosteroids was the most cost-effective first-line strategy (incremental cost-effectiveness ratio £20 000 per QALY), followed by TCA (am/pm) (£22 658 per QALY) and TCF product (£179 439 per QALY). For scalp psoriasis, initial treatment with very potent corticosteroids generated the most QALYs, followed by TCF product and then potent corticosteroids. Very potent corticosteroids were the most cost-effective treatment but, if too aggressive, potent corticosteroids were optimal followed by TCF product (£219 846 per QALY). The cost-effectiveness of second- and third-line topical agents varied with the assumptions made.
Potent corticosteroids, used alone or in combination with vitamin D, are the most cost-effective treatment for patients with psoriasis of the trunk and limbs. Potent or very potent corticosteroids are the most cost-effective treatment for patients with scalp psoriasis.