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
Autor para correspondencia
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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| año/Mes | Html | Total | |
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| 2023 Marzo | 19 | 23 | 42 |
| 2023 Febrero | 31 | 23 | 54 |
| 2023 Enero | 36 | 23 | 59 |
| 2022 Diciembre | 31 | 42 | 73 |
| 2022 Noviembre | 16 | 22 | 38 |
| 2022 Octubre | 24 | 17 | 41 |
| 2022 Septiembre | 21 | 34 | 55 |
| 2022 Agosto | 53 | 30 | 83 |
| 2022 Julio | 19 | 27 | 46 |
| 2022 Junio | 18 | 21 | 39 |
| 2022 Mayo | 25 | 38 | 63 |
| 2022 Abril | 43 | 53 | 96 |
| 2022 Marzo | 57 | 53 | 110 |
| 2022 Febrero | 33 | 37 | 70 |
| 2022 Enero | 22 | 34 | 56 |
| 2021 Diciembre | 35 | 39 | 74 |
| 2021 Noviembre | 32 | 50 | 82 |
| 2021 Octubre | 25 | 41 | 66 |
| 2021 Septiembre | 27 | 28 | 55 |
| 2021 Agosto | 29 | 29 | 58 |
| 2021 Julio | 43 | 22 | 65 |
| 2021 Junio | 45 | 35 | 80 |
| 2021 Mayo | 29 | 20 | 49 |
| 2021 Abril | 48 | 62 | 110 |
| 2021 Marzo | 55 | 18 | 73 |
| 2021 Febrero | 59 | 31 | 90 |
| 2021 Enero | 21 | 11 | 32 |
| 2020 Diciembre | 34 | 8 | 42 |
| 2020 Noviembre | 23 | 16 | 39 |
| 2020 Octubre | 19 | 8 | 27 |
| 2020 Septiembre | 43 | 7 | 50 |
| 2020 Agosto | 26 | 23 | 49 |
| 2020 Julio | 26 | 10 | 36 |
| 2020 Junio | 30 | 19 | 49 |
| 2020 Mayo | 37 | 16 | 53 |
| 2020 Abril | 27 | 16 | 43 |
| 2020 Marzo | 35 | 15 | 50 |
| 2020 Febrero | 0 | 1 | 1 |
| 2020 Enero | 0 | 4 | 4 |
| 2019 Diciembre | 0 | 12 | 12 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Octubre | 0 | 4 | 4 |
| 2019 Septiembre | 0 | 3 | 3 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 7 | 7 |
| 2019 Junio | 0 | 7 | 7 |
| 2019 Mayo | 0 | 43 | 43 |
| 2019 Abril | 0 | 17 | 17 |
| 2019 Marzo | 0 | 7 | 7 |
| 2019 Febrero | 0 | 3 | 3 |
| 2018 Junio | 0 | 5 | 5 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 16 | 2 | 18 |
| 2018 Enero | 20 | 3 | 23 |
| 2017 Diciembre | 22 | 10 | 32 |
| 2017 Noviembre | 16 | 3 | 19 |
| 2017 Octubre | 13 | 5 | 18 |
| 2017 Septiembre | 15 | 6 | 21 |
| 2017 Agosto | 30 | 5 | 35 |
| 2017 Julio | 14 | 3 | 17 |
| 2017 Junio | 28 | 7 | 35 |
| 2017 Mayo | 28 | 9 | 37 |
| 2017 Abril | 20 | 11 | 31 |
| 2017 Marzo | 18 | 9 | 27 |
| 2017 Febrero | 24 | 8 | 32 |
| 2017 Enero | 25 | 17 | 42 |
| 2016 Diciembre | 60 | 11 | 71 |
| 2016 Noviembre | 24 | 4 | 28 |
| 2016 Octubre | 28 | 17 | 45 |
| 2016 Septiembre | 38 | 10 | 48 |
| 2016 Agosto | 30 | 10 | 40 |
| 2016 Julio | 38 | 6 | 44 |
| 2016 Junio | 12 | 8 | 20 |
| 2016 Mayo | 7 | 11 | 18 |
| 2016 Abril | 9 | 0 | 9 |
| 2016 Marzo | 2 | 0 | 2 |
| 2016 Febrero | 4 | 2 | 6 |
| 2016 Enero | 10 | 0 | 10 |
| 2015 Diciembre | 4 | 0 | 4 |
| 2015 Noviembre | 15 | 3 | 18 |
| 2015 Octubre | 4 | 1 | 5 |
| 2015 Septiembre | 6 | 4 | 10 |
| 2015 Agosto | 14 | 5 | 19 |
| 2015 Julio | 20 | 16 | 36 |
| 2015 Junio | 20 | 2 | 22 |
| 2015 Mayo | 60 | 14 | 74 |
| 2015 Abril | 43 | 18 | 61 |
| 2015 Marzo | 25 | 10 | 35 |
| 2015 Febrero | 34 | 8 | 42 |
| 2015 Enero | 29 | 9 | 38 |
| 2014 Diciembre | 25 | 15 | 40 |
| 2014 Noviembre | 23 | 15 | 38 |
| 2014 Octubre | 29 | 10 | 39 |
| 2014 Septiembre | 30 | 14 | 44 |
| 2014 Agosto | 39 | 11 | 50 |
| 2014 Julio | 37 | 15 | 52 |
| 2014 Junio | 34 | 15 | 49 |
| 2014 Mayo | 38 | 11 | 49 |
| 2014 Abril | 40 | 5 | 45 |
| 2014 Marzo | 46 | 24 | 70 |
| 2014 Febrero | 45 | 12 | 57 |
| 2014 Enero | 39 | 18 | 57 |
| 2013 Diciembre | 40 | 14 | 54 |
| 2013 Noviembre | 33 | 14 | 47 |
| 2013 Octubre | 28 | 15 | 43 |
| 2013 Septiembre | 23 | 16 | 39 |
| 2013 Agosto | 29 | 17 | 46 |
| 2013 Julio | 35 | 42 | 77 |
| 2013 Junio | 38 | 26 | 64 |
| 2013 Mayo | 25 | 34 | 59 |
| 2013 Abril | 29 | 41 | 70 |
| 2013 Marzo | 32 | 22 | 54 |
| 2013 Febrero | 26 | 17 | 43 |
| 2013 Enero | 7 | 3 | 10 |
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