Original articles
Efficiency of Biologic Agents in the Treatment of Moderate to Severe Psoriasis
Eficiencia de los Agentes Biológicos en el Tratamiento de la Psoriasis Moderada-Grave
A.J. Blascoa,
, P. Lázaroa, C. Ferrándizb, A. García-Díezc, J. Lisod
Corresponding author
ablasco@taiss.com
Correspondence: Técnicas Avanzadas de Investigación en Servicios de Salud (TAISS), Cambrils, 41-2, 28034 Madrid, Spain.
Correspondence: Técnicas Avanzadas de Investigación en Servicios de Salud (TAISS), Cambrils, 41-2, 28034 Madrid, Spain.
a Técnicas Avanzadas de Investigación en Servicios de Salud, Madrid, Spain
b Servicio de Dermatología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain
c Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, Spain
d Servicio de Atención Farmacéutica Especializada, Complejo Hospitalario Universitario de Badajoz, Spain
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Liso" "autores" => array:5 [ 0 => array:4 [ "nombre" => "A.J." "apellidos" => "Blasco" "email" => array:1 [ 0 => "ablasco@taiss.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "P." "apellidos" => "Lázaro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Ferrándiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "García-Díez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Liso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Técnicas Avanzadas de Investigación en Servicios de Salud, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Servicio de Atención Farmacéutica Especializada, Complejo Hospitalario Universitario de Badajoz, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondence: Técnicas Avanzadas de Investigación en Servicios de Salud (TAISS), Cambrils, 41-2, 28034 Madrid, Spain." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eficiencia de los Agentes Biológicos en el Tratamiento de la Psoriasis Moderada-Grave" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaAceptado" => "2009-05-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec84591" "palabras" => array:4 [ 0 => "psoriasis" 1 => "efficiency" 2 => "biologic agents" 3 => "meta-analysis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec84592" "palabras" => array:4 [ 0 => "psoriasis" 1 => "eficiencia" 2 => "terapia biológica" 3 => "metanálisis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p class="elsevierStyleSimplePara elsevierViewall">In the treatment of psoriasis, biologic agents are more expensive than conventional therapy while showing similar or superior efficacy. However, their efficiency in terms of cost/efficacy (cost per responder in clinical trial conditions) is unknown.</p> <span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To estimate the cost/efficacy ratios of adalimumab, etanercept, infliximab, and efalizumab in the management of moderate to severe psoriasis.</p> <span class="elsevierStyleSectionTitle">Material and Methods</span><p class="elsevierStyleSimplePara elsevierViewall">A model for costs analysis was elaborated by building a decision tree for each of the treatments for which scientific evidence was available. The payer perspective (Spanish national health system) was used, only considering drug costs. The efficacy (proportion of patients who respond according to Psoriasis Area and Severity Index [PASI] 75 criterion) was assigned according to the results of the clinical trials. When more than 1 trial was available per treatment, a meta-analysis was undertaken. In the case of weight-dependent dosing, the weight of the study participants was adjusted by age and sex to the standard Spanish population with correction for increased weight in individuals with psoriasis. Uncertainty was investigated with a sensitivity analysis.</p> <span class="elsevierStyleSectionTitle">Results and Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Assigning the efficacy reported in the 15 published clinical trials, the most efficient biologic agent in terms of the cost/efficacy ratio was adalimumab, with one PASI75 response at a cost of €8013.</p><p class="elsevierStyleSimplePara elsevierViewall">For the remaining biologic agents and with different regimens, the cost per responder ranged from €9370 to €17 112. The sensitivity analysis confirmed the robustness of these figures.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p class="elsevierStyleSimplePara elsevierViewall">Los agentes biológicos en el tratamiento de la psoriasis son más caros y, en general, de eficacia similar o superior que la terapia clásica. Sin embargo, se desconoce su eficiencia en términos de coste/eficacia (coste por cada paciente que responde en las condiciones de los ensayos clínicos).</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Estimar los cocientes de coste/eficacia de adalimumab, etanercept, infliximab y efalizumab en el manejo de la psoriasis moderada-grave.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Modelo de evaluación económica, construyendo un árbol de decisión para cada uno de los tratamientos sobre los que existe evidencia científica. Se ha usado la perspectiva del financiador (Sistema Nacional de Salud), considerando sólo los costes del fármaco. La eficacia (proporción de pacientes que responden con el criterio PASI-75) asignada es la que consta en los ensayos clínicos. Cuando había más de un ensayo para cada tratamiento se han realizado metanálisis. Cuando la dosis depende del peso, este último en los sujetos del estudio se ha estandarizado por edad y sexo a la población española, corregido por el incremento de peso de los sujetos con psoriasis. La incertidumbre se ha manejado mediante análisis de sensibilidad.</p> <span class="elsevierStyleSectionTitle">Resultados y conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Asignando en los modelos la eficacia de los 15 ensayos clínicos publicados, el agente biológico más eficiente en términos de coste/eficacia es adalimumab, con el que se consigue un respondedor PASI75 a un coste de 8.013 euros. Con el resto de los biológicos y con diferentes pautas el coste/respondedor osciló entre 9.370 € y 17.112 €. El análisis de sensibilidad confirma la robustez de estos hallazgos.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 13 | 17 |
| 2024 October | 57 | 55 | 112 |
| 2024 September | 58 | 38 | 96 |
| 2024 August | 97 | 69 | 166 |
| 2024 July | 55 | 44 | 99 |
| 2024 June | 88 | 31 | 119 |
| 2024 May | 42 | 27 | 69 |
| 2024 April | 49 | 35 | 84 |
| 2024 March | 43 | 38 | 81 |
| 2024 February | 57 | 40 | 97 |
| 2024 January | 45 | 46 | 91 |
| 2023 December | 40 | 34 | 74 |
| 2023 November | 53 | 30 | 83 |
| 2023 October | 29 | 22 | 51 |
| 2023 September | 37 | 21 | 58 |
| 2023 August | 24 | 15 | 39 |
| 2023 July | 25 | 42 | 67 |
| 2023 June | 45 | 25 | 70 |
| 2023 May | 38 | 25 | 63 |
| 2023 April | 26 | 27 | 53 |
| 2023 March | 19 | 23 | 42 |
| 2023 February | 31 | 23 | 54 |
| 2023 January | 36 | 23 | 59 |
| 2022 December | 31 | 42 | 73 |
| 2022 November | 16 | 22 | 38 |
| 2022 October | 24 | 17 | 41 |
| 2022 September | 21 | 34 | 55 |
| 2022 August | 53 | 30 | 83 |
| 2022 July | 19 | 27 | 46 |
| 2022 June | 18 | 21 | 39 |
| 2022 May | 25 | 38 | 63 |
| 2022 April | 43 | 53 | 96 |
| 2022 March | 57 | 53 | 110 |
| 2022 February | 33 | 37 | 70 |
| 2022 January | 22 | 34 | 56 |
| 2021 December | 35 | 39 | 74 |
| 2021 November | 32 | 50 | 82 |
| 2021 October | 25 | 41 | 66 |
| 2021 September | 27 | 28 | 55 |
| 2021 August | 29 | 29 | 58 |
| 2021 July | 43 | 22 | 65 |
| 2021 June | 45 | 35 | 80 |
| 2021 May | 29 | 20 | 49 |
| 2021 April | 48 | 62 | 110 |
| 2021 March | 55 | 18 | 73 |
| 2021 February | 59 | 31 | 90 |
| 2021 January | 21 | 11 | 32 |
| 2020 December | 34 | 8 | 42 |
| 2020 November | 23 | 16 | 39 |
| 2020 October | 19 | 8 | 27 |
| 2020 September | 43 | 7 | 50 |
| 2020 August | 26 | 23 | 49 |
| 2020 July | 26 | 10 | 36 |
| 2020 June | 30 | 19 | 49 |
| 2020 May | 37 | 16 | 53 |
| 2020 April | 27 | 16 | 43 |
| 2020 March | 35 | 15 | 50 |
| 2020 February | 0 | 1 | 1 |
| 2020 January | 0 | 4 | 4 |
| 2019 December | 0 | 12 | 12 |
| 2019 November | 0 | 1 | 1 |
| 2019 October | 0 | 4 | 4 |
| 2019 September | 0 | 3 | 3 |
| 2019 August | 0 | 1 | 1 |
| 2019 July | 0 | 7 | 7 |
| 2019 June | 0 | 7 | 7 |
| 2019 May | 0 | 43 | 43 |
| 2019 April | 0 | 17 | 17 |
| 2019 March | 0 | 7 | 7 |
| 2019 February | 0 | 3 | 3 |
| 2018 June | 0 | 5 | 5 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 0 | 1 | 1 |
| 2018 February | 16 | 2 | 18 |
| 2018 January | 20 | 3 | 23 |
| 2017 December | 22 | 10 | 32 |
| 2017 November | 16 | 3 | 19 |
| 2017 October | 13 | 5 | 18 |
| 2017 September | 15 | 6 | 21 |
| 2017 August | 30 | 5 | 35 |
| 2017 July | 14 | 3 | 17 |
| 2017 June | 28 | 7 | 35 |
| 2017 May | 28 | 9 | 37 |
| 2017 April | 20 | 11 | 31 |
| 2017 March | 18 | 9 | 27 |
| 2017 February | 24 | 8 | 32 |
| 2017 January | 25 | 17 | 42 |
| 2016 December | 60 | 11 | 71 |
| 2016 November | 24 | 4 | 28 |
| 2016 October | 28 | 17 | 45 |
| 2016 September | 38 | 10 | 48 |
| 2016 August | 30 | 10 | 40 |
| 2016 July | 38 | 6 | 44 |
| 2016 June | 12 | 8 | 20 |
| 2016 May | 7 | 11 | 18 |
| 2016 April | 9 | 0 | 9 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 4 | 2 | 6 |
| 2016 January | 10 | 0 | 10 |
| 2015 December | 4 | 0 | 4 |
| 2015 November | 15 | 3 | 18 |
| 2015 October | 4 | 1 | 5 |
| 2015 September | 6 | 4 | 10 |
| 2015 August | 14 | 5 | 19 |
| 2015 July | 20 | 16 | 36 |
| 2015 June | 20 | 2 | 22 |
| 2015 May | 60 | 14 | 74 |
| 2015 April | 43 | 18 | 61 |
| 2015 March | 25 | 10 | 35 |
| 2015 February | 34 | 8 | 42 |
| 2015 January | 29 | 9 | 38 |
| 2014 December | 25 | 15 | 40 |
| 2014 November | 23 | 15 | 38 |
| 2014 October | 29 | 10 | 39 |
| 2014 September | 30 | 14 | 44 |
| 2014 August | 39 | 11 | 50 |
| 2014 July | 37 | 15 | 52 |
| 2014 June | 34 | 15 | 49 |
| 2014 May | 38 | 11 | 49 |
| 2014 April | 40 | 5 | 45 |
| 2014 March | 46 | 24 | 70 |
| 2014 February | 45 | 12 | 57 |
| 2014 January | 39 | 18 | 57 |
| 2013 December | 40 | 14 | 54 |
| 2013 November | 33 | 14 | 47 |
| 2013 October | 28 | 15 | 43 |
| 2013 September | 23 | 16 | 39 |
| 2013 August | 29 | 17 | 46 |
| 2013 July | 35 | 42 | 77 |
| 2013 June | 38 | 26 | 64 |
| 2013 May | 25 | 34 | 59 |
| 2013 April | 29 | 41 | 70 |
| 2013 March | 32 | 22 | 54 |
| 2013 February | 26 | 17 | 43 |
| 2013 January | 7 | 3 | 10 |
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