Methotrexate is the most cost-effective systemic treatment for psoriasis in terms of the number of patients needed to treat to achieve a PASI 75, according to a literature review in the Journal of the American Academy of Dermatology.
Methotrexate (2.5-mg tablet) cost an adjusted $794-$1,503 a month per number needed to treat (NNT) for a 75% reduction in Psoriasis Area and Severity Index (PASI 75) score, Dr. Logan S. D’Souza and Dr. Michael J. Payette of the department of dermatology at the University of Connecticut in Farmington reported (J. Am. Acad. Dermatol. 2015 Jan. 25 [doi:10.1016/j.jaad.2014.11.028]).
Coming in second was cyclosporine (25- and 100-mg tablets) at $1,410-$1,844 in monthly cost per PASI 75, followed by narrow-band ultraviolet B light phototherapy at $2,925 and adalimumab (40-mg subcutaneous injection) at $3,975-$7,679, the investigators said.
The most expensive of the 10 Food and Drug Administration–approved treatments included in the study was infliximab (100-mg vial) at $8,705-$15,236 per month. The next most expensive treatment was ustekinumab (90-mg subcutaneous injection), which cost $12,505-$14,257 per month.
“While our data indicate that methotrexate and cyclosporine are more cost efficacious in reaching PASI 75 than other medications approved by the FDA, their potential toxicities may limit their long-term use,” Dr. D’Souza and Dr. Payette noted. “Our study is not meant to dictate treatments based solely on costs; rather, our analysis should help both clinicians and patients in choosing between potential treatments,” they added.
For this analysis, 26 studies involving 7,099 patients and 39 treatment regimens met the investigators’ search criteria.
Dr. D’Souza declared no conflicts of interest. Dr. Payette has been an adviser to Amgen.