Pharmacoeconomic model of topical treatment options of mild to moderate psoriasis vulgaris in Germany

Augustin M, Radtke M, Engen A van, Ruedig C, Lapp C, Moehling U 
JDDG J German Soc Dermatol 2009; 7(4): 329-338                     
Background: Psoriasis vulgaris is one of the most common dermatologic diseases in Germany with a prevalence of about 2 %. Along with efficacy and safety, costs are an important criterion for selecting appropriate therapy for this chronic disease. The majority of the patients with mild to moderate psoriasis vulgaris can be successfully treated with topical therapy alone. The most important agents are vitamin D3 analogs and corticosteroids either as single agents or in a fixed combination (Daivobet®).
Methods: For the evaluation of the cost-effectiveness of different topical psoriasis treatments, a Markov model was developed that compares a fixed combination treatment followed by calcipotriol with a morning/evening application of the individual agents, as well as a comparison with tacalcitol.
Results: The pharmacoeconomic evaluation showed a higher cost-effectiveness of the fixed combination treatment compared to using single agents (morning/evening) and to the tacalcitol. Treatment with the fix combination is more effective and more economic. Additional sensitivity analyses demonstrated that the advantage remains even when assuming a maximum compliance for twice daily usage, and varying the effectiveness of the fixed combination by 10 %.
Conclusions: The treatment of mild to moderate psoriasis with a fixed calcipotriol/betamethasone combination is a more cost-effective treatment than a treatment with the single agents or tacalcitol monotherapy.