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Journal of the American Academy of Dermatology
Volume 46, n° 2
pages 242-250 (février 2002)
Doi : 10.1067/mjd.2002.119196
Cost-effectiveness comparison of therapy for psoriasis with a methotrexate-based regimen versus a rotation regimen of modified cyclosporine and methotrexate

Charles N. Ellis, MDa, Kristin L. Reiter, MAEb, Rajesh R. Bandekar, PhDc, A.Mark Fendrick, MDd
Ann Arbor, Michigan 
From the Department of Dermatology,a University of Michigan Medical School and the Dermatology Service,a Department of Veterans Affairs Ann Arbor Healthcare System, and Michigan Health Services Research,b the Department of Health Management and Policy,b,d and the Department of Biostatistics,c University of Michigan School of Public Health, and the Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies (CHOICES)c,d and Division of General Medicine,d Department of Internal Medicine, University of Michigan Medical School 


Background: Because health care resources are limited, therapeutic regimens should be assessed for their relative costs and effectiveness. Objective: We assessed cost-effectiveness for treating psoriasis using two strategies: one consisted principally of methotrexate and the other was principally a rotational schedule of modified cyclosporine (Neoral) with methotrexate. Methods: We performed a cost-effectiveness analysis using a computerized decision analytic model of simulated patients with moderate to severe psoriasis. Patients were randomly assigned to receive treatment with one of the two strategies. Direct costs included acquisition of medications, laboratory and physician fees, and costs of treating side effects. Because of uncertainty regarding rates of clearing of psoriasis, the relative efficacy of methotrexate and cyclosporine was varied over a wide range in a sensitivity analysis. Results: In the base case over a 10-year treatment period, the methotrexate strategy cost $33,000 and provided approximately 2 years clear of psoriasis compared with $38,000 and approximately 4 years clear of psoriasis for the rotational strategy. When the relative effectiveness of cyclosporine to methotrexate in clearing psoriasis varied from approximately 1 to 20, the rotational strategy cost from $4100 to $2700 per incremental clear year. Conclusion: In selecting therapies for psoriasis patients, both costs and effectiveness should be considered. In this simulation, patients could obtain additional periods clear of psoriasis at an incremental cost by using cyclosporine in rotation with methotrexate. If even a small utility gain accompanies the complete clearing of psoriasis, such a strategy may be a worthwhile investment of resources comparable to other healthcare interventions. (J Am Acad Dermatol 2002;46:242-50.)

The full text of this article is available in PDF format.

 Supported by an educational grant to the University of Michigan Medical School from Novartis Pharmaceuticals Corp, which had no part in the preparation, design, analysis, or interpretation of this study; and by the Alumni Fund of the Department of Dermatology, University of Michigan Medical School.
 Disclosure: Dr Ellis serves as a consultant to Novartis Pharmaceuticals Corp.
 Reprint requests: Charles N. Ellis, MD, Department of Dermatology, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0314.

*  *At the maximum incremental cost of the rotational strategy (approximately $4100 when the relative clearing efficacy of methotrexate and cyclosporine approach 1, Fig. 3), the incremental utility required to achieve the accepted cost-effectiveness threshold of $50,000 is 0.08 ($4100/0.08 $50,000). If the relative efficacy of cyclosporine in achieving clearing were greater, the incremental utility required to achieve cost-effectiveness for the rotational strategy would be even lower than 0.08 (eg, $2700/0.054 = $50,000).

© 2002  American Academy of Dermatology, Inc. Published by Elsevier Masson SAS@@#104157@@
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