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Psoriasis Treatment Cost Comparison: Biologics Versus Home Phototherapy

An estimation and comparison of the cost of home phototherapy versus biologics over a 3-year time horizon in patients with moderate-to-severe plaque psoriasis.
Published Online: Feb 02,2018
Kimberly Hyde, MD; Leah A. Cardwell, MD; Ronnie Stotts, BS; Steven R. Feldman, MD, PhD
Abstract

Background: Psoriasis is a chronic inflammatory condition associated with considerable morbidity and economic burden.
Objectives: To estimate and compare the costs of home phototherapy versus biologics over a 3-year time horizon in patients with moderate to severe plaque psoriasis.
Methods: The biologics compared were adalimumab, etanercept, infliximab, ustekinumab, and secukinumab. Average wholesale prices of biologics were obtained through Lexicomp. Home phototherapy costs were estimated by obtaining quotes from phototherapy device manufacturers. Three-year cost horizon, 3-month cost, and cost per success were calculated. To assess cost-effectiveness, Psoriasis Area Severity Index (PASI) 75 rates served as the surrogate for the rate of treatment success. Cost per success represents the cost for 3 months of treatment relative to the percent of patients who achieved PASI 75.
Results: Secukinumab is the most expensive biologic with a 3-year cost of $182,718 compared with a 3-year cost of $5,000 for phototherapy.
Limitations: Studies on the efficacy of home phototherapy tended to have small sample sizes. Larger studies would be useful to improve the generalizability of the data. The cost estimates are an average, which may not accurately represent the costs different insurance companies negotiate. These limitations were considered to have minimal effect on analysis.
Conclusions: The economic burden of psoriasis is substantial. It is important to consider the costs to the healthcare system over a patient’s lifetime when they start biologics or home phototherapy. Phototherapy is an effective and economical option for the treatment of moderate to severe plaque psoriasis.

                                                                                         Am J Pharm Benefits. 2018; 10(1):18-21

Psoriasis is a chronic inflammatory condition associated with considerable morbidity and economic burden. Approximately 7.5 million adults in the United States are affected by this disorder; about 17% have moderate-to-severe disease.1–3 Treatment options for moderate-to-severe psoriasis include phototherapy, oral agents (including cyclosporine or methotrexate), and injectable biologics. Home phototherapy, perhaps the most cost-effective treatment in the long run, is safe and effective, and incurs relatively few costs: those of acquiring the equipment, initially, and of bulb replacement every 3 to 6 years.4 Acquisition of home units is often hindered by qualification protocols defined by each insurance company.5 Even when home units are covered, patients’ co-payment requirements may discourage their use, leading many to choose biologics instead.5

Biologic treatment has revolutionized the care of patients with moderate-to-severe psoriasis but is far more costly, overall, than other treatments. However, patient co-payments for biologics are often significantly less than the start-up costs for home phototherapy.6 The increasing cost to manage psoriasis can largely be attributed to the use of biologics in a relatively small percentage of patients.7 The total economic burden of psoriasis was estimated to be $112 billion in the United States for 2013.8

To assure good stewardship of medical resources, biologics should be used only in patients who need them, and appropriate incentives should guide treatment among the available options. Because of the rapid turnover of patients among insurance providers, a short time horizon may be more appropriate to assess the relative cost-effectiveness of home phototherapy versus biologics. The purpose of this study is to estimate and compare the cost of home phototherapy versus biologics over a 3-year time horizon in patients with moderate-to-severe plaque psoriasis.




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