By the same authors

From the same journal

From the same journal

Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation

Research output: Contribution to journalArticle

Standard

Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people : systematic review and economic evaluation. / Duarte, Ana; Mebrahtu, Teumzghi; Goncalves, Pedro Saramago; Harden, Melissa; Murphy, Ruth; Palmer, Stephen; Woolacott, Nerys; Rodgers, Mark; Rothery, Claire.

In: Health technology assessment, Vol. 21, No. 64, 06.11.2017.

Research output: Contribution to journalArticle

Harvard

Duarte, A, Mebrahtu, T, Goncalves, PS, Harden, M, Murphy, R, Palmer, S, Woolacott, N, Rodgers, M & Rothery, C 2017, 'Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation', Health technology assessment, vol. 21, no. 64. https://doi.org/10.3310/hta21640

APA

Duarte, A., Mebrahtu, T., Goncalves, P. S., Harden, M., Murphy, R., Palmer, S., ... Rothery, C. (2017). Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation. Health technology assessment, 21(64). https://doi.org/10.3310/hta21640

Vancouver

Duarte A, Mebrahtu T, Goncalves PS, Harden M, Murphy R, Palmer S et al. Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation. Health technology assessment. 2017 Nov 6;21(64). https://doi.org/10.3310/hta21640

Author

Duarte, Ana ; Mebrahtu, Teumzghi ; Goncalves, Pedro Saramago ; Harden, Melissa ; Murphy, Ruth ; Palmer, Stephen ; Woolacott, Nerys ; Rodgers, Mark ; Rothery, Claire. / Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people : systematic review and economic evaluation. In: Health technology assessment. 2017 ; Vol. 21, No. 64.

Bibtex - Download

@article{6b7c7e373de445bdb038e510caab9bf7,
title = "Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation",
abstract = "Background: Psoriasis is a chronic inflammatory disease that predominantly affects the skin. Adalimumab (HUMIRA{\circledR}, AbbVie, Maidenhead, UK), etanercept (Enbrel{\circledR}, Pfizer, New York, NY, USA) and ustekinumab (STELARA{\circledR}, Janssen Biotech, Inc., Titusville, NJ, USA) are the three biological treatments currently licensed for psoriasis in children. Objective: To determine the clinical effectiveness and cost-effectiveness of adalimumab, etanercept and ustekinumab within their respective licensed indications for the treatment of plaque psoriasis in children and young people. Data sources: Searches of the literature and regulatory sources, contact with European psoriasis registries, company submissions and clinical study reports from manufacturers, and previous National Institute for Health and Care Excellence (NICE) technology appraisal documentation. Review methods: Included studies were summarised and subjected to detailed critical appraisal. A network meta-analysis incorporating adult data was developed to connect the effectiveness data in children and young people and populate a de novo decision-analytic model. The model estimated the cost-effectiveness of adalimumab, etanercept and ustekinumab compared with each other and with either methotrexate or best supportive care (BSC), depending on the position of the intervention in the management pathway. Results: Of the 2386 non-duplicate records identified, nine studies (one randomised controlled trial for each drug plus six observational studies) were included in the review of clinical effectiveness and safety. Etanercept and ustekinumab resulted in significantly greater improvements in psoriasis symptoms than placebo at 12 weeks’ follow-up. The magnitude and persistence of the effects beyond 12 weeks is less certain. Adalimumab resulted in significantly greater improvements in psoriasis symptoms than methotrexate for some but not all measures at 16 weeks. Quality-of-life benefits were inconsistent across different measures. There was limited evidence of excess short-term adverse events; however, the possibility of rare events cannot be excluded. The majority of the incremental cost-effectiveness ratios for the use of biologics in children and young people exceeded NICE’s usual threshold for cost-effectiveness and were reduced significantly only when combined assumptions that align with those made in the management of psoriasis in adults were adopted. Limitations: The clinical evidence base for short-and long-term outcomes was limited in terms of total participant numbers, length of follow-up and the absence of young children. Conclusions: The paucity of clinical and economic evidence to inform the cost-effectiveness of biological treatments in children and young people imposed a number of strong assumptions and uncertainties. Health-related quality-of-life (HRQoL) gains associated with treatment and the number of hospitalisations in children and young people are areas of considerable uncertainty. The findings suggest that biological treatments may not be cost-effective for the management of psoriasis in children and young people at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year, unless a number of strong assumptions about HRQoL and the costs of BSC are combined. Registry data on biological treatments would help determine safety, patterns of treatment switching, impact on comorbidities and long-term withdrawal rates. Further research is also needed into the resource use and costs associated with BSC. Adequately powered randomised controlled trials (including comparisons against placebo) could substantially reduce the uncertainty surrounding the effectiveness of biological treatments in biologic-experienced populations of children and young people, particularly in younger children. Such trials should establish the impact of biological therapies on HRQoL in this population, ideally by collecting direct estimates of EuroQol-5 Dimensions for Youth (EQ-5D-Y) utilities.",
keywords = "Adalimumab/economics, Adolescent, Anti-Inflammatory Agents, Non-Steroidal/therapeutic use, Anti-Inflammatory Agents/therapeutic use, Child, Cost-Benefit Analysis, Dermatologic Agents/therapeutic use, Etanercept/therapeutic use, Humans, Psoriasis/drug therapy, Treatment Outcome, Ustekinumab/therapeutic use",
author = "Ana Duarte and Teumzghi Mebrahtu and Goncalves, {Pedro Saramago} and Melissa Harden and Ruth Murphy and Stephen Palmer and Nerys Woolacott and Mark Rodgers and Claire Rothery",
year = "2017",
month = "11",
day = "6",
doi = "10.3310/hta21640",
language = "English",
volume = "21",
journal = "Health technology assessment",
issn = "1366-5278",
publisher = "NHS National Institute for Health Research",
number = "64",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

T2 - Health technology assessment

AU - Duarte, Ana

AU - Mebrahtu, Teumzghi

AU - Goncalves, Pedro Saramago

AU - Harden, Melissa

AU - Murphy, Ruth

AU - Palmer, Stephen

AU - Woolacott, Nerys

AU - Rodgers, Mark

AU - Rothery, Claire

PY - 2017/11/6

Y1 - 2017/11/6

N2 - Background: Psoriasis is a chronic inflammatory disease that predominantly affects the skin. Adalimumab (HUMIRA®, AbbVie, Maidenhead, UK), etanercept (Enbrel®, Pfizer, New York, NY, USA) and ustekinumab (STELARA®, Janssen Biotech, Inc., Titusville, NJ, USA) are the three biological treatments currently licensed for psoriasis in children. Objective: To determine the clinical effectiveness and cost-effectiveness of adalimumab, etanercept and ustekinumab within their respective licensed indications for the treatment of plaque psoriasis in children and young people. Data sources: Searches of the literature and regulatory sources, contact with European psoriasis registries, company submissions and clinical study reports from manufacturers, and previous National Institute for Health and Care Excellence (NICE) technology appraisal documentation. Review methods: Included studies were summarised and subjected to detailed critical appraisal. A network meta-analysis incorporating adult data was developed to connect the effectiveness data in children and young people and populate a de novo decision-analytic model. The model estimated the cost-effectiveness of adalimumab, etanercept and ustekinumab compared with each other and with either methotrexate or best supportive care (BSC), depending on the position of the intervention in the management pathway. Results: Of the 2386 non-duplicate records identified, nine studies (one randomised controlled trial for each drug plus six observational studies) were included in the review of clinical effectiveness and safety. Etanercept and ustekinumab resulted in significantly greater improvements in psoriasis symptoms than placebo at 12 weeks’ follow-up. The magnitude and persistence of the effects beyond 12 weeks is less certain. Adalimumab resulted in significantly greater improvements in psoriasis symptoms than methotrexate for some but not all measures at 16 weeks. Quality-of-life benefits were inconsistent across different measures. There was limited evidence of excess short-term adverse events; however, the possibility of rare events cannot be excluded. The majority of the incremental cost-effectiveness ratios for the use of biologics in children and young people exceeded NICE’s usual threshold for cost-effectiveness and were reduced significantly only when combined assumptions that align with those made in the management of psoriasis in adults were adopted. Limitations: The clinical evidence base for short-and long-term outcomes was limited in terms of total participant numbers, length of follow-up and the absence of young children. Conclusions: The paucity of clinical and economic evidence to inform the cost-effectiveness of biological treatments in children and young people imposed a number of strong assumptions and uncertainties. Health-related quality-of-life (HRQoL) gains associated with treatment and the number of hospitalisations in children and young people are areas of considerable uncertainty. The findings suggest that biological treatments may not be cost-effective for the management of psoriasis in children and young people at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year, unless a number of strong assumptions about HRQoL and the costs of BSC are combined. Registry data on biological treatments would help determine safety, patterns of treatment switching, impact on comorbidities and long-term withdrawal rates. Further research is also needed into the resource use and costs associated with BSC. Adequately powered randomised controlled trials (including comparisons against placebo) could substantially reduce the uncertainty surrounding the effectiveness of biological treatments in biologic-experienced populations of children and young people, particularly in younger children. Such trials should establish the impact of biological therapies on HRQoL in this population, ideally by collecting direct estimates of EuroQol-5 Dimensions for Youth (EQ-5D-Y) utilities.

AB - Background: Psoriasis is a chronic inflammatory disease that predominantly affects the skin. Adalimumab (HUMIRA®, AbbVie, Maidenhead, UK), etanercept (Enbrel®, Pfizer, New York, NY, USA) and ustekinumab (STELARA®, Janssen Biotech, Inc., Titusville, NJ, USA) are the three biological treatments currently licensed for psoriasis in children. Objective: To determine the clinical effectiveness and cost-effectiveness of adalimumab, etanercept and ustekinumab within their respective licensed indications for the treatment of plaque psoriasis in children and young people. Data sources: Searches of the literature and regulatory sources, contact with European psoriasis registries, company submissions and clinical study reports from manufacturers, and previous National Institute for Health and Care Excellence (NICE) technology appraisal documentation. Review methods: Included studies were summarised and subjected to detailed critical appraisal. A network meta-analysis incorporating adult data was developed to connect the effectiveness data in children and young people and populate a de novo decision-analytic model. The model estimated the cost-effectiveness of adalimumab, etanercept and ustekinumab compared with each other and with either methotrexate or best supportive care (BSC), depending on the position of the intervention in the management pathway. Results: Of the 2386 non-duplicate records identified, nine studies (one randomised controlled trial for each drug plus six observational studies) were included in the review of clinical effectiveness and safety. Etanercept and ustekinumab resulted in significantly greater improvements in psoriasis symptoms than placebo at 12 weeks’ follow-up. The magnitude and persistence of the effects beyond 12 weeks is less certain. Adalimumab resulted in significantly greater improvements in psoriasis symptoms than methotrexate for some but not all measures at 16 weeks. Quality-of-life benefits were inconsistent across different measures. There was limited evidence of excess short-term adverse events; however, the possibility of rare events cannot be excluded. The majority of the incremental cost-effectiveness ratios for the use of biologics in children and young people exceeded NICE’s usual threshold for cost-effectiveness and were reduced significantly only when combined assumptions that align with those made in the management of psoriasis in adults were adopted. Limitations: The clinical evidence base for short-and long-term outcomes was limited in terms of total participant numbers, length of follow-up and the absence of young children. Conclusions: The paucity of clinical and economic evidence to inform the cost-effectiveness of biological treatments in children and young people imposed a number of strong assumptions and uncertainties. Health-related quality-of-life (HRQoL) gains associated with treatment and the number of hospitalisations in children and young people are areas of considerable uncertainty. The findings suggest that biological treatments may not be cost-effective for the management of psoriasis in children and young people at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year, unless a number of strong assumptions about HRQoL and the costs of BSC are combined. Registry data on biological treatments would help determine safety, patterns of treatment switching, impact on comorbidities and long-term withdrawal rates. Further research is also needed into the resource use and costs associated with BSC. Adequately powered randomised controlled trials (including comparisons against placebo) could substantially reduce the uncertainty surrounding the effectiveness of biological treatments in biologic-experienced populations of children and young people, particularly in younger children. Such trials should establish the impact of biological therapies on HRQoL in this population, ideally by collecting direct estimates of EuroQol-5 Dimensions for Youth (EQ-5D-Y) utilities.

KW - Adalimumab/economics

KW - Adolescent

KW - Anti-Inflammatory Agents, Non-Steroidal/therapeutic use

KW - Anti-Inflammatory Agents/therapeutic use

KW - Child

KW - Cost-Benefit Analysis

KW - Dermatologic Agents/therapeutic use

KW - Etanercept/therapeutic use

KW - Humans

KW - Psoriasis/drug therapy

KW - Treatment Outcome

KW - Ustekinumab/therapeutic use

UR - http://www.scopus.com/inward/record.url?scp=85034039513&partnerID=8YFLogxK

U2 - 10.3310/hta21640

DO - 10.3310/hta21640

M3 - Article

VL - 21

JO - Health technology assessment

JF - Health technology assessment

SN - 1366-5278

IS - 64

ER -