Hart-Hansen, K

Morais, JC

Morton, CA

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PSK4 COST-EFFECTIVENESS OF TOPICAL CALCIPOTRIOL/BETAMETHASONE DIPROPIONATE TWOCOMPOUND PRODUCT IN A SCOTTISH CARE MODEL 

A267Abstracts
Further investigations using larger cohorts are warranted to
better understand economic and patient-reported outcomes asso-
ciated with biologic treatment in psoriasis.
PSK3
A COST-EFFECTIVENESS ANALYSIS OF BIOLOGIC THERAPIES
FOR THE TREATMENT OF CHRONIC PLAQUE PSORIASIS
Roberts G1, Morris J2
1Oxford Outcomes Ltd, Oxford, Oxfordshire, UK, 2Schering-Plough
Ltd, Welwyn Garden City, Hertfordshire, UK
OBJECTIVES: Biologic therapies have been shown to be a safe
and effective treatment for chronic plaque psoriasis. However,
there appear to be notable differences in effectiveness between
treatment options. Given the considerable costs of these treat-
ments, their relative cost-effectiveness is an important consider-
ation. METHODS: A cost-effectiveness model was developed to
estimate the incremental cost per responder associated with each
biologic licensed in the UK for psoriasis. Data on response,
deﬁned as Psoriasis Area Severity Index (PASI) 75 or 90, were
derived from randomized controlled trials for efalizumab, etan-
ercept and inﬂiximab. An ordered probit model was used to
model response rates jointly. Treatment effects, deﬁned as
response rates, and direct health care costs from published
sources were modelled over a 1-year time-horizon. Costs
included in the analysis comprised drug acquisition, monitoring
and administration costs, as well as costs associated with out-
patient and inpatient hospital episodes. Treatment non-
responders were assumed to receive best supportive care. All
licensed regimens were included as potential treatment options.
RESULTS: In the analysis utilising PASI 75 response, efaluzimab
and etanercept 25 mg twice weekly (BIW) continuous, were dom-
inated by other regimens. Of the remaining strategies, etanercept
25 mg BIW had the lowest ICER vs. supportive care (response
rate 31.78%, £8891 per responder gained), followed by inﬂix-
imab (78.79%, £11,302) and then etanercept 50 mg continuous,
(45.99%, £12,598). For PASI 90 response, the same two strate-
gies were dominated. However inﬂiximab was the most effective
and had the lowest ICER vs. supportive care (response rate
56.65%, £15,721 per responder gained) followed by etanercept
25 mg BIW (12.34%, £22,907) then etanercept 50 mg continu-
ous, (21.58%, £26,853). CONCLUSIONS: Provided decision-
makers are willing to pay up to approximately £12,000 to gain
an additional PASI 75 responder and also value clearance of
symptoms (PASI 90 responder), treatment with inﬂiximab is
likely to represent the most cost-effective strategy.
PSK4
COST-EFFECTIVENESS OF TOPICAL
CALCIPOTRIOL/BETAMETHASONE DIPROPIONATE TWO-
COMPOUND PRODUCT IN A SCOTTISH CARE MODEL
Morton CA1, Morais JC2, Hart-Hansen K3
1Falkirk & District Royal Inﬁrmary, Falkirk, Scotland, UK, 2LEO Pharma,
Princes Risborough, Buckinghamshire, England, 3LEO Pharma, Ballerup,
Denmark
OBJECTIVES: UVB phototherapy is an effective treatment for
psoriasis, typically introduced after a patient with widespread
disease has failed to respond to a couple of topical agents. A
pharmacoeconomic model was devised to analyse the cost impli-
cations of different treatment combinations based on a Scottish
model of care. METHODS: A calcipotriol/betamethasone dipro-
pionate two-compound product was assessed alongside two of
the UK’s most commonly prescribed topical antipsoriatic agents
(calcipotriol and betamethasone valerate in several different
treatment regimens to determine the most cost-effective treat-
ment A Markov chain approach was used to model the pro-
gression of psoriatic patients through the response or non-
response to 4 weeks treatment with different topical agents. The
patient pathway consisted of two four-week treatments with ﬁrst
and second line topical agents before referral to secondary care
and phototherapy. Non-responders (i.e. those who did not
achieve PASI-75) on ﬁrst line treatment were then given a second
line topical agent. Those who failed again were referred to sec-
ondary care and waited 6 months before completing 20 treat-
ments of phototherapy. One hundred patients were evaluated in
each of the six different treatment pathways over one year to
determine overall cost per patient. RESULTS: Mean annual cost
per patient showed that the most cost-effective treatment
regimen used the two compound product as ﬁrst and second line
treatments. It was 19.7% cheaper (≤690.99 vs ≤860.62) and
32% fewer patients required phototherapy (30 vs 44) when com-
pared to the next best regimen which used the two-compound
product and calcipotriol as ﬁrst and second line treatments
respectively. CONCLUSION: This pharmacoeconomic evalua-
tion demonstrates that the two-compound product, when used
as an initial therapy in psoriasis, could result in a reduction in
overall costs per patient and in fewer patients requiring pho-
totherapy. This in turn, could improve access to phototherapy
for more patients with light-responsive dermatoses.
PSK5
COST OF ATOPIC DERMATIS IN ADULTS: THE CODA STUDY
De Portu S1, Scalone L2, Monzini MS2, Ziccardi M1, Baranzoni N3,
Giannetti A3, Mantovani LG1
1University of Naples, Federico II, Naples, Italy, 2University of Milan,
Milan, Italy, 3Policlinico Hospital, University of Modena and Reggio
Emilia, Modena, Italy
OBJECTIVES: The aim of the Costi-&-Outcomes-in-Dermatite-
Atopica (CODA) study was to evaluate the socioeconomic
impact of AD. METHODS: The CODA study was a naturalis-
tic, multicentre, longitudinal ambispective (retro-prospective),
prevalence based Cost Of Illness study. Data on patients with
moderate or severe AD enrolled during ﬂare-up was collected:
socio-demographic, clinical (SCORing-Atopic-Dermatitis index
(SCORAD): 0 = no disease; 100 = maximum manifestation) eco-
nomic (direct and indirect costs), HRQoL (intangible costs),
preferences towards pharmacological treatment. The following
results pertain to the economic burden of AD and its treatment
in adult patients. The analysis was conducted from the societal
perspective with a 3 month time horizon. Direct medical costs
(hospitalizations, drugs, cosmetics, personal health supplies, spe-
cialist visits, diagnostics and laboratory exams) were quantiﬁed
using prices or tariffs expressed in Euro 2005. Also indirect cost,
in terms of productivity losses by patients, were calculated using
human capital approach. RESULTS: We erolled 104 valid adults
from 6 Italian dermatological referral centres (males 53.8%,
mean age = 32.9 ± 11.8 y.o.). At the enrolment the median
SCORAD was 52.0 while after 2 months was 18.0 (p < 0.0001
Wilcoxon Signed Rank test). Direct cost/patient/month was at
baseline 369.6 ± 440.0€: 28.8% hospitalizations, 19.9% drugs,
16.0% cosmetics. After 2 months from the enrolment direct
cost/patient/month was €188.1 ± €236.1: 42.5% drugs, 35.2%
cosmetics, 8.8% hospitalizations. The decrease in direct cost
during the follow up period was statistically signiﬁcant (p = <
0.0001 paired samples t test). Indirect cost/patient/month was
€247.0 ± €626.5 at baseline and €32.8 ± €106.1 after 2 months
(p = < 0.0001). CONCLUSION: This is the ﬁrst study evaluat-
ing the socio-economic impact of AD in Italy. The difference
between cost during relapse period and after 2 months is signif-
icant. Among adult patients hospitalisations and drugs are the
cost drivers at baseline and after 2 months respectively. High cost


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PSK4 COST-EFFECTIVENESS OF TOPICAL CALCIPOTRIOL/BETAMETHASONE DIPROPIONATE TWOCOMPOUND PRODUCT IN A SCOTTISH CARE MODEL

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