Comparing the Cost-Effectiveness of Phototherapy and Biologics for Psoriasis and Atopic Dermatitis Treatment

A comprehensive study published in the International Journal of Dermatology found that comparing the cost-effectiveness of phototherapy and FDA-approved biologics for the treatment of psoriasis and atopic dermatitis found that phototherapy may be the most cost-effective therapy for psoriasis and least expensive per treatment period for atopic dermatitis. Still, factors like disease severity and patient compliance may favor biologic therapy. 

Psoriasis and atopic dermatitis are chronic inflammatory skin conditions that affect around 2–3% of the US adult population, and phototherapy such as narrowband ultraviolet-B (NB-UVB) has long been used as treatment. However, no comprehensive study has yet compared the cost efficacy of phototherapy to FDA-approved biologics for these conditions. 

Researchers systematically reviewed the literature to assess the efficacy of NB-UVB or biologics in treating psoriasis and eczema, using the Psoriasis Area and Severity Index (PASI) and the Eczema Area and Severity Index (EASI) as endpoints. The analysis included 34 studies with a total of 55 treatment regimens and 5,123 patients.  

Costs were estimated using Medicare fee schedules for phototherapy-related CPT codes and wholesale acquisition cost for biologics. The total costs required to achieve PASI 75 or EASI 75 in each study to a single month, referred to as the "adjusted cost," were standardized and then extrapolated to a year, known as the "effective yearly cost," allowing for direct cost-efficacy comparisons despite variations in treatment durations across studies. 

The analysis of psoriasis treatments showed that NB-UVB therapy had the lowest adjusted monthly cost of $1714.00 per PASI 75, making it the most cost-effective option. Among biologics, Infliximab was found to be the least expensive, ranging from $2076.00 to $2502.00 per PASI 75. Unfortunately, for atopic dermatitis, there were no NB-UVB studies that used EASI 75 as their outcome measure, which made it difficult to directly compare cost-effectiveness. However, all NB-UVB studies did show a lower treatment cost per treatment period compared to studies on biologics, although this comparison did not consider efficacy. NB-UVB was found to be the most cost-effective for psoriasis and the least expensive per treatment period for atopic dermatitis, but certain factors need to be considered. 

“Biologics may be more effective for more severe disease, do not require multiple weekly clinic visits, and the ease for patient compliance may lead some to favor biologic therapy,” said researchers. "This study is necessary to allow physicians, patients, and health systems to make informed decisions regarding cost-efficacy for a variety of treatment options.”  

Reference 

McCoy T, Natarelli N, Pan A, et al. Systematic review and estimated cost-efficacy of biologics compared with narrowband ultraviolet B light for the treatment of moderate to severe psoriasis and atopic dermatitis. Inter Journal of Derm. 2023;62(8):986-999. doi: 10.1111/ijd.16677