S. Chen et al., Cost-effectiveness and cost-benefit analysis of using methotrexate vs Goeckerman therapy for psoriasis - A pilot study, ARCH DERMAT, 134(12), 1998, pp. 1602-1608
Objective: To analyze the net benefit and cost-effectiveness of methotrexat
e use and Goeckerman therapy for psoriasis.
Design: Net benefit and cost-effectiveness depend on the costs, efficacy, a
nd utilities of therapy. Utilities are quantitative measures of patient pre
ferences. We obtained costs by using resource-based accounting techniques.
Efficacy was estimated from literature reports. We surveyed patients with p
soriasis, dermatologists, and healthy subjects using utility assessment met
hods. All assumptions were examined in a sensitivity analysis.
Main Outcome Measures: For net benefit, if benefits outweighed the costs, i
t was deemed worth providing. For the cost-effectiveness analysis, the rati
o of costs-to-effectiveness of less than $35 000 was considered cost-effect
ive.
Results: Using utilities from healthy nonexperts, the costs of both therapi
es exceeded the benefits in mild and moderate psoriasis. In severe psoriasi
s, only methotrexate demonstrates a net benefit. Both therapies were cost-e
ffective compared with no therapy. Liquid methotrexate should be chosen ove
r 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-effecti
ve 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 settin
gs, but they demonstrate that the tools of cost-effectiveness and cost-bene
fit analysis have great potential value in dermatology. Once efficacy is be
tter characterized and utilities better quantified, these types of analyses
will be crucial for health care policy.