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Cost-effectiveness and Cost-Benefit Analysis of Using Methotrexate vs Goeckerman Therapy for Psoriasis

1998; American Medical Association; Volume: 134; Issue: 12 Linguagem: Inglês

10.1001/archderm.134.12.1602

1538-3652

Suephy C. Chen, Allison Shaheen, Alan M. Garber,

Health Systems, Economic Evaluations, Quality of Life

Objective:To analyze the net benefit and costeffectiveness of methotrexate use and Goeckerman therapy for psoriasis.Design: Net benefit and cost-effectiveness depend on the costs, efficacy, and utilities of therapy.Utilities are quantitative measures of patient preferences.We obtained costs by using resource-based accounting techniques.Efficacy was estimated from literature reports.We surveyed patients with psoriasis, dermatologists, and healthy subjects using utility assessment methods.All assumptions were examined in a sensitivity analysis.Main Outcome Measures: For net benefit, if benefits outweighed the costs, it was deemed worth providing.For the cost-effectiveness analysis, the ratio of costs-to-effectiveness of less than $35 000 was considered cost-effective.Results: Using utilities from healthy nonexperts, the costs of both therapies exceeded the benefits in mild and moderate psoriasis.In severe psoriasis, only methotrexate demonstrates a net benefit.Both therapies were cost-effective compared with no therapy.Liquid methotrexate should be chosen over the tablet form since it was cheaper and had the same outcome.Goeckerman was cost-effective against liquid methotrexate in severe, but not mild or moderate psoriasis.There was a trend for therapies to be more cost-effective when using patient utilities and less with dermatologist utilities.The results were highly sensitive to efficacy and utilities. Conclusions:The results of this study need to be confirmed in other settings, but they demonstrate that the tools of cost-effectiveness and cost-benefit analysis have great potential value in dermatology.Once efficacy is better characterized and utilities better quantified, these types of analyses will be crucial for health care policy.