Dosing schedules.

Objective
In Malaysia, there is now a dearth of recommendations pertaining to the priority of biologic treatments for the effective management of psoriasis, given the multitude of available therapeutic alternatives. Present analysis reports results of a cost-effectiveness model that determines the most optimal arrangement of biologic treatments, with a particular focus of adding biosimilars to the existing treatment pathway for psoriasis in Malaysia.
Methods
A Markov model was developed to compare the cost effectiveness of various biologic sequential treatments in a hypothetical cohort of moderate to severe psoriasis patient in Malaysia over a lifetime horizon. The model simulated the progression of patients through three lines of active biologic therapy, before transitioning to best supportive care. Costs and effects were discounted annually at a rate of 3%.
Results
First line secukinumab has produced lowest incremental cost effectiveness ratios (ICERs) when compared to first line systemic [ICERs value; US$152,474 (first set analysis) and US$110,572 (second set analysis)] and first line phototherapy [ICERs value; US$147,057 (first set analysis) and US$107,616 (second set analysis)]. However, these values were slightly higher than the Malaysian based threshold of three times gross domestic product per capita, US$104,337. A 40% reduction in the unit costs of reference biologics renders most of the evaluated treatment sequences cost-effective.
Conclusion
Adding biosimilar to the current treatment sequence could achieve cost savings ranging from 4.3% to 10.8% without significant loss of effectiveness. Given the significant impact of comorbidities and the resulting decline in quality of life among individuals with psoriasis, it may be justifiable to establish a threshold of up to US$184,000 per quality-adjusted life year (QALY) for the provision of therapies in the context of Malaysia.

研究目的

鉴于马来西亚当前针对银屑病的有效管理拥有多种治疗选择，但缺乏关于生物制剂治疗优先级的权威推荐方案。本研究报告了一款成本效益模型的分析结果，该模型旨在确定最优的生物制剂治疗方案排布，重点探讨将生物类似药（biosimilars）纳入马来西亚现行银屑病治疗路径。

研究方法

本研究构建马尔可夫（Markov）模型，针对马来西亚中度至重度银屑病患者的假设队列，在终身随访周期内，比较多种序贯生物制剂治疗方案的成本效益。该模型模拟患者依次接受三线活性生物制剂治疗，随后转入最佳支持治疗。成本与健康产出均按3%的年贴现率进行贴现。

研究结果

与一线系统治疗的增量成本效益比（incremental cost effectiveness ratios, ICERs）分别为152,474美元（第一组分析）及110,572美元（第二组分析），以及一线光疗的增量成本效益比（ICERs）分别为147,057美元（第一组分析）及107,616美元（第二组分析）相比，一线司库奇尤单抗（secukinumab）的增量成本效益比最低。但上述数值略高于马来西亚以人均国内生产总值3倍为标准的阈值（104,337美元）。若原研生物制剂的单位成本降低40%，则绝大多数评估的序贯治疗方案均可实现成本效益。

研究结论

将生物类似药（biosimilars）纳入现行治疗序列，可实现4.3%至10.8%的成本节约，且不会显著降低治疗有效性。鉴于银屑病患者合并症对生活质量的显著负面影响，在马来西亚医疗语境下，将每质量调整生命年（quality-adjusted life year, QALY）184,000美元的阈值标准具备合理性。