Number needed to treat and costs per responder among biologic treatments for moderate-to-severe psoriasis: a network meta-analysis
Number needed to treat and costs per responder among biologic treatments for moderate-to-severe psoriasis: a network meta-analysis
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DOI：
10.1080/03007995.2018.1457516
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发表时间：
2018-01-01
影响因子：
2.3
通讯作者：
Wu, Eric Q.
中科院分区：
文献类型：
--
作者：
Armstrong, April W.;Betts, Keith A.;Wu, Eric Q.
背景：生物疗法治疗中重度牛皮癣的临床益处已经确立，但患者的反应存在很大差异。目的：确定使用fda批准的药物治疗银屑病面积和严重程度指数（PASI-75/90）降低75%和90%所需的治疗人数（NNT），并评估每个PASI-75或PASI-90应答者的增量成本。方法：使用网络meta分析估计达到PASI-75和PASI-90以及nnt的相对概率。成本（2017年美元）包括药品采购和管理。每个治疗的PASI-75或PASI-90应答者的增量成本在临床试验期间和每年进行估计。结果：与支持治疗相比，实现PASI-75的NNT为：ixekizumab 1.18, secukinumab 300mg 1.29，英夫利昔单抗1.37，阿达木单抗1.48,secukinumab 150mg 1.53, ustekinumab 1.58，依那西普2.25，阿普利米司特3.71。相对于支持治疗，每一种PASI-75反应药的一年增量成本为英夫利昔单抗59,830美元，secukinumab 300mg 88,775美元，阿达木单抗91,837美元，ixekizumab 95,898美元，ustekinumab 97,363美元，secukinumab 150mg 105,131美元，阿普拉米司特129,665美元，依那西普159,328美元。PASI-90的结果相似。结论：NNT和每个应答者的增量成本是评估银屑病治疗比较疗效和成本效益的有意义的方法。
Background: The clinical benefits of biologic therapies for moderate-to-severe psoriasis are well established, but wide variations exist in patient response.Objectives: To determine the number needed to treat (NNT) to achieve a 75% and 90% reduction in the Psoriasis Area and Severity Index (PASI-75/90) with FDA-approved agents and evaluate the incremental cost per PASI-75 or PASI-90 responder.Methods: The relative probabilities of achieving PASI-75 and PASI-90, as well as NNTs, were estimated using a network meta-analysis. Costs (2017 USD) included drug acquisition and administration. The incremental cost per PASI-75 or PASI-90 responder for each treatment was estimated for the clinical trial period, and annually.Results: Compared with supportive care, the NNT to achieve PASI-75 was 1.18 for ixekizumab, 1.29 for secukinumab 300mg, 1.37 for infliximab, 1.48 for adalimumab, 1.53 for secukinumab 150mg, 1.58 for ustekinumab, 2.25 for etanercept, and 3.71 for apremilast. The one-year incremental cost per PASI-75 responder relative to supportive care was $59,830 for infliximab, $88,775 for secukinumab 300mg, $91,837 for adalimumab, $95,898 for ixekizumab, $97,363 for ustekinumab, $105,131 for secukinumab 150mg, $129,665 for apremilast, and $159,328 for etanercept. Results were similar for PASI-90.Conclusion: The NNT and incremental cost per responder are meaningful ways to assess comparative effectiveness and cost effectiveness among psoriasis treatments.