Cost differences of methotrexate and cyclosporine to treat psoriasis neglible

The difference in cost associated with using two common treatments for psoriasis over the course of one year with treatment lasting 16 weeks are small, according to an article in the June issue of the Archives of Dermatology, one of the JAMA/Archives journals.

Psoriasis is a chronic skin disease for which there is no cure. Methotrexate and cyclosporine are the two most common systemic (as opposed to topically applied) treatments for patients with moderate to severe psoriasis and have been used for the past 40 and 20 years, respectively. Both medications have been studied and are effective at minimizing psoriasis, however, their unit costs are different.

Brent C. Opmeer, Ph.D., from the University of Amsterdam, the Netherlands, and colleagues compared the direct and indirect medical costs and nonmedical costs of treating psoriasis with methotrexate (n=43) vs. cyclosporine (n=42) in 85 adult patients with moderate to severe psoriasis with no previous use of the two medications. Patients enrolled in the study between October 13, 1998 and June 15, 2000 and were treated for 16 weeks with an additional 36 weeks of follow-up. Direct costs were those generated by using health care resources (medication, diagnostic procedures, and visits to health care professionals). Indirect costs were associated with lost or impaired ability to work or to engage in leisure-time activities.

The researchers found that the average cumulative costs associated with 16 weeks of treatment with methotrexate were $1,593 and were $2,114 for 16 weeks of treatment with cyclosporine. During the 36 weeks of follow-up, costs were $2,418 for the methotrexate group and $2,306 for the cyclosporine group. The overall difference in annual cost was $409, about 10 percent of the total cost.

"After one year, the overall difference in total costs between methotrexate and cyclosporine for 16 weeks of treatment and follow-up is relatively small. Systemic medication costs are only a fraction of the costs directly and indirectly generated by utilization of health care resources and associated with individual patients rather than with methotrexate or cyclosporine," the authors write.

"Economic arguments can be supportive of but not decisive for individual patient decisions and guidelines for systemic therapy. Rational decision making for the treatment of psoriasis may include costs only within a long-term horizon and may consider the societal and patient benefits of different alternatives," the researchers conclude.