Acta Dermato-Venereologica 99-4CompleteContent | Page 11

393 CLINICAL REPORT A Cost-utility Analysis of Calcipotriol/Betamethasone Dipropionate Aerosol Foam versus Ointment for the Topical Treatment of Psoriasis Vulgaris in Sweden Albert DUVETORP 1 , Lars-Åke LEVIN 2 , Emma ENGERSTEDT MATTSSON 3 and Lasse RYTTIG 3 1 Skåne University Hospital, Malmö, 2 Department of Medical and Health Sciences, Linköping University, Linköping, Sweden, and 3 LEO Pharma A/S, Ballerup, Denmark Psoriasis is a chronic inflammatory disorder that im- poses a substantial economic burden. We conducted a cost-utility analysis from a Swedish healthcare payer’s perspective using a decision-tree model with a 12- week time horizon. Patients with psoriasis vulgaris could have two 4-week cycles of topical treatment with calcipotriol 50 µg/g and betamethasone 0.5 mg/g as dipropionate (Cal/BD) foam or Cal/BD ointment before progressing to phototherapy/methotrexate. In the base-case analysis, Cal/BD foam dominated over Cal/BD ointment. The increased efficacy of Cal/BD foam resulted in fewer consultations and a decreased risk of progressing to phototherapy/methotrexate. Although Cal/BD foam costs more than Cal/BD oint- ment, this was offset by lower costs for phototherapy/ methotrexate or consultation visits. Sensitivity analy- ses revealed that the base-case net monetary benefit was robust to plausible variations in key parameters. In conclusion, Cal/BD foam was predicted to be more cost-effective than Cal/BD ointment in the treatment of psoriasis vulgaris. Key words: psoriasis; cost-utility analysis; calcipotriol; betame- thasone dipropionate. Accepted Jan 7, 2019; E-published Jan 9, 2019 Acta Derm Venereol 2019; 99: 393–399. Corr: Lasse Ryttig, LEO Pharma A/S, DK-2750 Ballerup, Denmark. E- mail: [email protected] P soriasis is a chronic inflammatory disorder with a prevalence of 4–9% in Northern Europe (1). It is a chronic and heterogeneous disease with an unpredictable course and progression (2), which often does not fol- low a progressive course but rather a periodic pattern of remissions and flare-ups. Psoriasis has a significant detrimental impact on patients’ health-related quality of life, as well as imposing a substantial economic burden on society (3, 4). Topical treatment is often sufficient in patients with mild-to-moderate psoriasis (5), with combined topical therapy with a vitamin D analogue and a corticosteroid shown to have greater efficacy than any single compo- nent alone (6). Systemic treatment (e.g. methotrexate) or phototherapy may be indicated in patients who do not respond to the first-line topical therapy (5). Methotrexate SIGNIFICANCE Psoriasis is a chronic heterogenous disorder with a substan- tial impact on patients and healthcare systems. We  eva- luated the cost-effectiveness of Cal/BD foam versus Cal/ BD ointment over a 12-week time horizon in patients with psoriasis, from a Swedish healthcare perspective. In our model, the superior efficacy of Cal/BD foam over ointment led to fewer consultation visits, a decreased risk of progres- sing to second-line therapy, and lower total costs. Impro- ved topical therapies, such as Cal/BD foam, have the po- tential to reduce the need for some patients to progress to phototherapy and/or systemic treatment, which may lead to a reduction in the overall treatment costs of psoriasis. is the most commonly prescribed systemic agent for psoriasis in Sweden (7). Ointment, gel and aerosol foam formulations with a fix- ed combination of calcipotriol 50 µg/g and betamethasone 0.5 mg/g as dipropionate (Cal/BD) are available for the topical treatment of adults with psoriasis vulgaris (8, 9). Previous European cost-effectiveness analyses have shown that Cal/BD ointment or gel is more cost-effective compared with monotherapy with Cal or BD (or another potent corticosteroid) (10–12), morning application of Cal and evening application of BD (or another potent corticosteroid) (10, 11, 13, 14) or other topical therapies (11–13, 15). The clinical efficacy of Cal/BD aerosol foam formu- lation (Enstilar ® ) in patients with psoriasis vulgaris was established in Phase II and III trials. In Phase II trials, significantly (p < 0.05) higher treatment success rates (assessed using the Physician Global Assessment [PGA] of disease severity, a 5-point severity scale [‘clear’, ‘almost clear’, ‘mild’, ‘moderate’, ‘severe’]) were seen with Cal/BD foam than with Cal foam or BD foam alone (NCT01536938) (16) or with Cal/BD ointment (NCT01536886) (17). In Phase III trials, patients using Cal/BD foam experienced significantly (p < 0.001) higher treatment success rates (assessed using PGA) than pa- tients using vehicle (PSO-FAST study; NCT01866163) (18) or Cal/BD gel (PSO-ABLE study; NCT02132936) (19). In these Phase III trials, significantly (p < 0.001) more patients using Cal/BD foam than vehicle achieved This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3112 Acta Derm Venereol 2019; 99: 393–399