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NHS-健保乾癬藥價評估
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國內的健保藥價,如果是新藥,主要是參考先進10國藥價的最低價,其中經濟評估主要是看英國及美國(NHS: national institute for health research economic evaluation),舉例而言,對於中重度乾癬,其2010評估結果為:

The percentage change in PASI from baseline to end point was 96.3% with acitretin 25, 57.0% with acitretin 50, 33.4% with cyclosporine 1.25, 52% with cyclosporine 3.0, 58.4% with methotrexate 7.5, 50.9% with methotrexate 15, 76.3% with adalimumab, 45.0% with alefacept, 46.8% with efalizumab, 55.0% with etanercept 25, 66.3% with etanercept 50, 82.8% with infliximab, 64.7% with UVB (bbUVB 47.0~83.7%; nbUVB 73.0%), 69.6% with psoralen and UVA, and 97.3% with psoralen, UVA, and acitretin, 80.7% with UVB plus acitretin

The total annual costs were $8,272 with acitretin 25, $16,034 with acitretin 50, $3,423 with cyclosporine 1.25, $4,180 with cyclosporine 3.0, $2,033 with methotrexate 7.5, $6,589 with methotrexate 15, $18,705 with adalimumab, $21,058 with alefacept, $20,762 with efalizumab, $11,080 with etanercept 25, $22,159 with etanercept 50, $22,616 with infliximab, $6,334 with UVB, $6,508 with psoralen and UVA, and $12,157 with psoralen, UVA, and acitretin.

The risks associated with treatments were 2% (annual incidence) with UVB associated NMSC, 1.2% (5-year risk) with PUVA-associated NMSC, 8.25% of patients need lipid-lowering agents with acitretin, 18% need calcium channel antagonist with cyclosporine, 4.13% need lipid-lowering agents and 1% NMSC 5-yr risk with Re-UVB, 4.13% need lipid-lowering agents and 2% NMSC 5-yr risk with Re-PUVA

The average costs to achieve a 1% improvement in PASI were $86 with acitretin 25, $281 with acitretin 50, $102 with cyclosporine 1.25, $80 with cyclosporine 3.0, $35 with methotrexate 7.5, $129 with methotrexate 15, $245 with adalimumab, $468 with alefacept, $444 with efalizumab, $201 with etanercept 25, $334 with etanercept 50, $273 with infliximab, $98 with UVB, $94 with psoralen and UVA, and $125 with psoralen, UVA, and acitretin.

The average costs to achieve a 75% PASI improvement were $6,442 with acitretin 25, $21,097 with acitretin 50, $7,685 with cyclosporine 1.25, $6,029 with cyclosporine 3.0, $2,611 with methotrexate 7.5, $9,708 with methotrexate 15, $18,386 with adalimumab, $35,096 with alefacept, $33,272 with efalizumab, $15,109 with etanercept 25, $25,067 with etanercept 50, $20,486 with infliximab, $7,342 with UVB, $7,013 with psoralen and UVA, and $9,371 with psoralen, UVA, and acitretin.

Authors' conclusions

The authors concluded that their cost-effectiveness estimates ranged from a low of $2,611 per clinical improvement with methotrexate 7.5mg weekly to a high of $35,096 with alefacept 15mg weekly and the relative positioning of oral medications, phototherapy, and biologic agents had not changed since their previous analysis.

Drug Benefit Trends. 2005;17:200-214

張貼日期:2013/2/13