Cost-Effectiveness Analysis of Biologics in the Treatment of Moderate-to-Severe Plaque Psoriasis from a Health Care Provider's Perspective

Introduction: Psoriasis (psoriasis) is a chronic disease with a number of significant comorbidities and often with a very significant impact on the quality of life of patients. Recently, a relatively large number of biological treatment products with a significant effect have entered the market, but they are also significantly more expensive than systemic conventional treatment. In the context of the published long period of inadequate treatment of patients with psoriasis in the Czech Republic, the health care system and the limited costs of center drugs, it is necessary to make the greatest possible effort at the level of the provider of this health care to effectively spend financial resources and provide highly effective treatment to the greatest possible number of patients. Method: With a model-set amount of the unit prices of the packaging of preparations according to the maximum reimbursements in the Czech Republic in 2021, a fictitiously set amount of bonuses for only two selected preparations (this is a model example that does not reflect the real state of business policy at the University Hospital Olomouc), and the conditions for reimbursement of biological treatment preparations psoriasis in the Czech Republic in 2021, a cost-effectiveness analysis (CEA) was carried out in the selected PASI 100 efficiency parameter. The analysis was carried out and processed interactively in the Excel software into the graphical form of the outputs, especially in the form of forest plot graphs (in the CER and ICER parameters) and in a two-dimensional efficient frontiers graph (costs vs. efficiency). Results: The differences in the cost-effectiveness of individual preparations according to the point values of the CER and ICER parameters are up to several times. Taking into account the 95% confidence intervals, some of the differences between the preparations are also statistically significant. With the most cost-effective sequence of treatment for a gradually more effective drug in one patient during the induction period of treatment, we can, based on the saved costs, start induction treatment with a less effective biologic in two more patients than when using the second cost-effective sequence of treatment escalation. Conclusion: The cost-effectiveness analysis (CEA) of biological drugs in the treatment of psoriasis at the level of the health service provider has great potential in the effort to make the treatment as effective as possible with limited financial resources, or in the effort to provide effective treatment to additional patients with the same limitations