A psoriasis-specific model to support decision making in practice – UK experience

Abstract

Objectives:

The balance of service provision for people with psoriasis across community and hospital sectors is inappropriate in many localities. Disease-specific models are being used by policy makers to inform public health decision making and guide their long-term budgets. The aim of the present study was to develop an interactive psoriasis model to compare the 2-year outcomes of topical treatment strategies in patients with moderately severe psoriasis in real-world settings.

Research design and methods:

A previously published 1-year economic analysis of the two-compound formulation (TCF) calcipotriol plus betamethasone dipropionate and other commonly used topical agents in plaque psoriasis was adapted. Literature review and an interview programme identified additional relevant data to inform model assumptions. The model estimated local psoriasis costs and resources in accord with decision makers’ priorities. A key element of the model was the facility for all default input data to be adapted to reflect local circumstance. Model validation was not undertaken. The UK experience is described.

Results:

Topical treatment with high-efficacy first-line therapies is a cost-effective treatment strategy in moderate plaque psoriasis. The model predicts potential savings in psoriasis care for a UK population of £126 million over 2 years if all psoriasis patients received the TCF in a community setting. A frequently used feature of the model was to identify ways of reducing inappropriate referrals to hospital, and so enabling secondary care resources to be focussed on the most resilient psoriasis cases.

Conclusions:

The present study psoriasis disease model could facilitate collaboration between healthcare professionals to optimise healthcare in the UK. Psoriasis management strategies in primary care can be compared in a variety of realistic clinical settings, allowing the identification of optimal treatment regimens. This model is adaptable to tailor inputs to reflect local situations, providing an attractive tool to GP commissioners. Country-specific adaptations are being researched in other European countries.

Key words::

• Costs
• Cost-effectiveness
• Economic modelling
• Hospital referrals
• PASI 75
• Psoriasis
• Resources
• Risk share agreements
• Waiting time targets

Transparency

Declaration of funding

This study was supported by LEO Pharma A/S who funded Amygdala’s consulting services.

Declaration of financial/other relationships

J.R. and P.J. have disclosed that they are employees of LEO Pharma UK. M.M. has disclosed that she is an employee of the National Association of Primary Care (NAPC). The NAPC collaborated with LEO Pharma in developing this model. K.F. has disclosed that he is an employee of Co. Durham and Darlington NHS Foundation Trust & Sunderland TPCT. K.F. has received funding from LEO Pharma to attend dermatology conferences, to chair the North of England Psoriasis Consensus Group and to make presentations to healthcare professionals on psoriasis and dermatology service design/delivery. K.F. has received funding from Pfizer, Galderma and Abbott for similar activities. J.B. and M.A. have disclosed that they are employees of Amygdala Ltd and have received funding from LEO Pharma A/S.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgements

Abacus International provided the visual basic programming aspects to the final model under a consultancy services agreement with Amygdala Ltd.

Notes

* Dovobet is a registered trademark of LEO Pharma A/S, Denmark.

* PASI 75 is the proportion of patients in whom a ≥75% reduction in PASI relative to baseline is achieved.