Annual biologic treatment cost for new and existing patients with moderate to severe plaque psoriasis in Greece

Figures & data

Table 1 Unit costs per item used in the model

Description	Cost (€)
Drug prices*
Adalimumab (Humira 40 mg/0.8 mL ×1 prefilled syringe)	381.39
Etanercept (Enbrel 50 mg/1 mL ×4 prefilled syringes)	756.96
Infliximab (Remicade injectable 100 mg/vial, 1 vial)	426.00
Ustekinumab (Stelara 45 mg/0.5 mL vial, 1 vial)	2,449.81
Resource use
Subcutaneous injection**	6.64
Day care hospitalization	85.00

Notes:

* Based on the Ministry of Health price bulletin of August 30, 2013;³⁷

** cost of subcutaneous injection was based on cost of personnel time for 22 minutes (€18/hour) by Fragoulakis et al.⁶²

Table 2 Mean annual per patient cost of treatment (€)

Drug	Mean (95% LCI–95% UCI)
	New patients		Existing Patients
	Nonresponders	Responders	Responders
Adalimumab	3,821 (3,549–4,086)	10,686 (9,927–11,429)	9,916 (9,212–10,606)
Etanercept	3,224 (3,017–3,430)	10,415 (10,295–10,579)	9,462 (7,829–11,000)
Infliximab	7,582 (6,640–7,793)	14,738 (13,280–155,863)	12,949 (11,619–13,637)
Ustekinumab	9,806 (9,566–10,045)	17,155 (16,755–17,554)	17,149 (16,749–17,547)

Notes: Existing patients are assumed to be those continuing treatment after the first year. Results were based upon 20,000 Monte Carlo iterations.

Abbreviations: LCI, lower confidence interval; UCI, upper confidence interval.

Table 3 One-way sensitivity analysis (annual per patient cost, €)

	Mean (95% LCI – 95% UCI)
	New patients		Existing patients
	Nonresponders	Responders	Responders
Mean weight of patients at 89 kg*
Adalimumab	3,821 (3,549–4,086)	10,686 (9,927–11,429)	9,916 (9,212–10,606)
Etanercept	3,224 (3,017–3,430)	10,415 (10,295–10,579)	9,462 (7,829–11,000)
Infliximab	8,008 (7,356–8,489)	16,016 (14,712–16,977)	14,227 (12,873–14,855)
Ustekinumab	9,806 (9,566–10,045)	17,155 (16,755–17,554)	17,149 (16,749–17,548)
Mean weight of patients at 73 kg*
Adalimumab	3,821 (3,549–4,086)	10,686 (9,927–11,429)	9,916 (9,212–10,606)
Etanercept	3,224 (3,017–3,430)	10,415 (10,295–10,579)	9,462 (7,829–11,000)
Infliximab	6,730 (5,979–7,149)	13,460 (11,958–14,299)	11,671 (10,463–12,511)
Ustekinumab	9,806 (9,566–10,045)	17,155 (16,755–17,554)	17,149 (16,749–17,548)
All ustekinumab patients on 45 mg
Adalimumab	3,821 (3,549–4,086)	10,686 (9,927–11,429)	9,916 (9,212–10,606)
Etanercept	3,224 (3,017–3,430)	10,415 (10,295–10,579)	9,462 (7,829–11,000)
Infliximab	7,582 (6,640–7,793)	14,738 (13,280–15,586)	12,949 (11,619–13,637)
Ustekinumab	7,356 (6,835–7,872)	12,256 (11,388–13,115)	12,249 (11,382–13,108)
50% etanercept patients 2×50 mg/week for the first 12 weeks
Adalimumab	3,821 (3,549–4,086)	10,686 (9,927–11,429)	9,916 (9,212–10,606)
Etanercept	3,413 (2,841–3,979)	10,793 (8,949–12,525)	9,462 (7,843–10,993)
Infliximab	7,582 (6,640–7,793)	14,738 (13,280–15,586)	12,949 (11,619–13,637)
Ustekinumab	9,806 (9,566–10,045)	17,155 (16,755–17,554)	17,149 (16,749–17,547)
75% etanercept patients 2×50 mg/week for the first 12 weeks
Adalimumab	3,821 (3,549–4,086)	10,686 (9,927–11,429)	9,916 (9,212–10,606)
Etanercept	3,981 (3,691–4,262)	11,361 (11,014–11,585)	9,462 (7,821–10,981)
Infliximab	7,582 (6,640–7,793)	14,738 (13,280–15,586)	12,949 (11,619–13,637)
Ustekinumab	9,806 (9,566–10,045)	17,155 (16,755–17,554)	17,149 (16,749–17,547)
Etanercept treatment holiday cycles, 10 months on/2 months off**
Adalimumab	3,821 (3,549–4,086)	10,686 (9,927–11,429)	9,916 (9,212–10,606)
Etanercept	3,224 (3,017–3,430)	10,604 (10,374–10,655)	9,651 (8,023–11,245)
Infliximab	7,582 (6,640–7,793)	14,738 (13,280–15,586)	12,949 (11,619–13,637)
Ustekinumab	9,806 (9,566–10,045)	17,155 (16,755–17,554)	17,149 (16,749–17,547)
30% patients etanercept intermittent, 6 months on/4 months off
Adalimumab	3,821 (3,549–4,086)	10,686 (9,927–11,429)	9,916 (9,212–10,606)
Etanercept	3,224 (3,017–3,430)	9,847 (9,579–9,860)	8,894 (7,407–10,386)
Infliximab	7,582 (6,640–7,793)	14,738 (13,280–155,863)	12,949 (11,619–13,637)
Ustekinumab	9,806 (9,566–10,045)	17,155 (16,755–17,554)	17,149 (16,749–17,547)

Notes:

* Although the mean weight changes, we assumed that the proportion of patients weighting >100 kg remains the same;

** refers to the 11.2% of patients receiving intermittent treatment as in the base case scenario.

Abbreviations: LCI, lower confidence interval; UCI, upper confidence interval.

Table S1 The treatment schedule of etanercept for responders

Year	Weeks	Dosing schedule for etanercept
1	1–12	36.90% patients 2×50 mg/week	63.10% patients 1×50 mg/week
	Response assessment
	13–24	100% patients 1×50 mg/week
	25–52	88.80% patients Continuous 50 mg/week	9.91% patients Intermittent 50 mg/week (cycles of 3 months off, 6 months on after week 24)	1.29% patients Intermittent 50 mg/week (cycles of 2 months off, 6 months on after week 24)
2	53–104	88.80% patients Continuous 50 mg/week	9.91% patients Intermittent 50 mg/week (cycles of 3 months off, 6 months on, continuing from Year 1)	1.29% patients Intermittent 50 mg/week (cycles of 2 months off, 6 months on, continuing from Year 1)

Notes: Response is assessed after 12 weeks of treatment; therefore, nonresponders were assumed to have received treatment for a total of 12 weeks and then stopped treatment.

Table S2 The treatment schedule of adalimumab for responders

Year	Weeks	Dosing schedule for adalimumab
1	0	80 mg	100%
	1, 3, 5 … 51 (dosing every 2 weeks)	40 mg	100%
2	53, 55, 57 … 103 (dosing every 2 weeks)	40 mg	100%

Notes: Response is assessed after 16 weeks of treatment; therefore, nonresponders were assumed to have received treatment for a total of 16 weeks and then stopped treatment.

Table S3 The treatment schedule of infliximab for responders

Year	Weeks	Dosing schedule for infliximab
1	0, 2, 6	5 mg/kg	100%
	14, 22, 30, 38, 46	5 mg/kg	100%
2	54, 62, 70, 78, 86, 94, 102	5 mg/kg	100%

Notes: Response is assessed after 14 weeks of treatment; therefore, nonresponders were assumed to have received treatment for a total of 14 weeks and then stopped treatment.

Table S4 The treatment schedule of ustekinumab for responders

Year	Weeks	Dosing schedule for infliximab
1	0, 4, 16, 28, 40, 52	45 mg	75%
		90 mg	25%
2	64, 76, 88, 100	45 mg	75%
		90 mg	25%

Notes: Response is assessed after 28 weeks of treatment; therefore, nonresponders were assumed to have received treatment for a total of 28 weeks and then stopped treatment.

Table S5 Cost calculations used in the analysis of the annual per patient cost of treatment

	Total dose (mg)	Weighted mean dose (mg)	Total vials (mean)	Drug cost (€)	Administration cost (€)	Total treatment cost (€)
Etanercept
Responders new patients
36.90% patients 2×50 mg/week up to week 12	3,135	2,756.40	55	10,408.20	6.64	10,414.84
63.10% patients 1×50 mg/week up to week 12	2,535	2,756.40	55	10,408.20	6.64	10,414.84
Responders existing patients
88.80% patients continuous	2,600	2,490.58	50	9,462.00	0	9,462.00
1.29% patients intermittent (8-week holiday)	1,800	2,490.58	50	9,462.00	0	9,462.00
9.91% patients intermittent (12-week holiday)	1,600	2,490.58	50	9,462.00	0	9,462.00
Nonresponders – 1st year
36.90% patients 2×50 mg/week up to week 12	1,200	821.40	17	3,217.08	6.64	3,223.72
63.10% patients 1×50 mg/week up to week 12	600	821.40	17	3,217.08	6.64	3,223.72
Adalimumab
Responders new patients	1,120	NA	28	10,678.92	6.64	10,685.56
Responders existing patients	1,040	NA	26	9,916.14	0	9,916.14
Nonresponders	400	NA	10	3,813.90	6.64	3,820.54
Infliximab
Responders new patients	3,230	NA	33	14,058.00	680.00	14,738.00
Responders existing patients	2,826	NA	29	12,354.00	595.00	12,949.00
Nonresponders	1,615	NA	17	7,242.00	340.00	7,582.00
Ustekinumab
Responders new patients
75% of patients 45 mg/dose	225	281.25	7	17,148.67	6.64	17,155.31
25% of patients 90 mg/dose	450	281.25	7	17,148.67	6.64	17,155.31
Responders existing patients
75% of patients 45 mg/dose	225	281.25	7	17,148.67	0	17,148.67
25% of patients 90 mg/dose	450	281.25	7	17,148.67	0	17,148.67
Nonresponders
75% of patients 45 mg/dose	135	168.75	4	9,799.24	6.64	9,805.88
25% of patients 90 mg/dose	270	168.75	4	9,799.24	6.64	9,805.88

Note: Existing patients are assumed to be those continuing treatment after the first year onwards; calculations are based on a 52-week per year time horizon.

Abbreviation: NA, not applicable.

Ministry of Health, price bulletin 81505/30-08-2013, YA Available at: http://www.moh.gov.gr/articles/times-farmakwn/deltia-timwn/1860-diorthwtiko-deltio-timwn-30-08-2013Accessed August 10, 2013 Greek

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