Comprehensive Analysis of Effectiveness and Cost-Effectiveness of Treatments for Psoriasis Integrating Clinician- and Patient-Reported Outcomes: A Cohort Study From SPEECH

Abstract

Effective and cost-effective management strategies for psoriasis are crucial for clinical decision-making. In the management of psoriasis, evidence concerning the effectiveness and cost-effectiveness of therapies from both clinicians’ and patients’ perspectives is vital for clinical decision-making. To compare the effectiveness and cost-effectiveness of acitretin, methotrexate, phototherapy, and biologics (adalimumab, ustekinumab, guselkumab, secukinumab, and ixekizumab) in treating chronic plaque psoriasis, we collected the data from the Shanghai Psoriasis Effectiveness Evaluation CoHort (SPEECH), an observational, multicenter, and prospective registry. Integrating both clinician- and patient-reported outcomes allows for a comprehensive evaluation of treatment impacts, capturing clinical disease improvements as well as patient-perceived quality of life enhancements, thereby providing a more complete perspective compared to analyses focusing solely on clinical outcomes. Proportions of patients achieving 75% improvement in Psoriasis Area and Severity Index (PASI 75), PASI 90, PASI 100, minimally important difference in Dermatology Life Quality Index (DLQI MID), DLQI 0/1, and Patient Global Assessment (PtGA) MID at 12 weeks were evaluated. The number needed to treat (NNT) and incremental cost per responder (ICPR) were computed for treatments relative to acitretin. A total of 1916 patients with chronic plaque psoriasis were analyzed, with 240 patients on acitretin, 459 on methotrexate, 391 on phototherapy, 64 on adalimumab, 164 on ustekinumab, 97 on guselkumab, 298 on secukinumab, and 203 on ixekizumab. At 12 weeks, patients on methotrexate (adjusted relative risk [RR], 2.03 [95% CI, 1.66–2.48]), phototherapy (RR, 2.01 [95% CI, 1.64–2.46]), adalimumab (RR, 2.22 [95% CI, 1.66–2.96]), ustekinumab (RR, 2.86 [95% CI, 2.27–3.62]), guselkumab (RR, 3.34 [95% CI, 2.54–4.38]), secukinumab (RR, 3.38 [95% CI, 2.74–4.16]), and ixekizumab (RR, 3.59 [95% CI, 2.88–4.47]) were more likely to achieve PASI 75 versus patients on acitretin. Comparable rankings were observed for PASI 90, PASI 100, DLQI MID, DLQI 0/1, and PtGA MID. Additionally, methotrexate and phototherapy demonstrated numerically lower ICPR values compared to other evaluated treatments, while ixekizumab exhibited the lowest ICPR among the biologics. Overall, our study indicated that ixekizumab, secukinumab, guselkumab, and ustekinumab demonstrated superior effectiveness compared to other therapies at 12 weeks. Methotrexate and phototherapy offered the best cost-effectiveness, while ixekizumab led in cost-effectiveness among biologics.