Pregled farmakoekonomskih analiza terapije atopijskog dermatititsa

master's thesis

• Title (english): Review of pharmacoeconomic analysis for atopic dermatitis therapy
• Author: Elena Matas
• Mentor: Petra Turčić (mentor)
• Committee member: Petra Turčić (predsjednik povjerenstva)
• Committee member: Ivan Pepić (član povjerenstva)
• Committee member: Nives Pustišek (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Centre for applied pharmacy); Zagreb
• Defense date and country: 2019-09-30, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

AD je česta, kronična, recidivirajuća, upalna bolest kože koja se pojavljuje u osoba s atopijskom konstitucijom. Prevalencija
je u djece 15 do 30%, a u odraslih 2 do 10%. AD je karakteriziran svrbežom, suhom kožom i crvenilom te je često udružen
s drugim atopijskim bolestima kao što su alergija, astma i alergijski rinitis. Etiopatogeneza je složena i još nije u potpunosti
razjašnjena. Klinička slika se može mijenjati od blagih do teških oblika bolesti. Dijagnoza se postavlja na temelju kliničke
slike, a procjena bolesti određuje se prema standardiziranim kriterijima i testovima za procjenu težine bolesti. AD ne samo
da utječe na kvalitetu života oboljelog i njegove obitelji, već je i teret za zdravstveni sustav. Zato se provode
farmakoekonomske analize, kojima je cilj usporediti troškove i učinkovitost terapije te pronaći onu najisplativiju. U jednoj
cost-effectiveness analizi dokazana je isplativost profilaktičkog nanošenja hidratacijskog sredstva na novorođenčad visokog
rizika oboljevanja od AD-a. Niskim ulaganjem u hidratacijska sredstva prvih šest mjeseci života, smanjuje se pojavnost
bolesti te posljedično manje pacijenta ima potrebu za skupocjenom terapijom u budućnosti. Kao najisplativija topikalna
terapija smatra se upotreba topikalnih kortikosteroida, te se analizom troška i koristi (cost-utility analysis, CUI) dokazala
prednost korištenja topikalnih kortikosteroida u odnosu na inhibitore kalcineurina (pimekrolimus) jer terapija košta manje
i učinkovitija je. Ako se nefarmakološke mjere i topikalna terapija pokažu neuspješnima, u terapiju se uvodi ciklosporin A
ili UVAB fototerapija. Analizom troška i učinkovitosti dokazana je prednost korištenja ciklosporina A u odnosu na UVAB
fototerapiju zbog velike količine vremena utrošenog u odlaske na mjesta gdje se nalazi uređaj za fototerapiju. U liječenju
AD-a , kao najnovija skupina lijekova, počinju se primjenjivati biološki lijekovi. Ekonomskom analizom procijenjena je
cijena dupilumaba, ovisna o vrijednosti, koja se smatra isplativom u odnosu na potpornu terapiju (emolijense) te je dokazano
da za prag potrošnje od 100000-15000$/QALY godišnja potrošnja dupilumaba mora biti između 29000-40000$ da bi se
terapija smatrala isplativom.

Abstract (english)

Atopic dermatitisis a common, chronic, recurrent, inflammatory skin disease that occurs in people with atopic constitution.
Prevalence is 15 to 30% in children and 2 to 10% in adults. Atopic dermatitis is characterized by itching, dry skin and
redness, and is often associated with other atopic diseases such as food allergy, asthma and allergic rhinitis.
Etiopathogenesis is complex and not fully understood. The clinical picture may change from mild to severe type of atopic
dermatitis. The diagnosis is made on the basis of clinical images, and the disease is determined according to standardized
criteria and tests for the evaluation of diseases. Atopic dermatitis does not only affect the quality of life of the patient and
his family, but is also an economic burden on the health system. Pharmacoeconomic analyzes are conducted to find the
most cost-effective therapy. Studies suggest that prophylactic moisturization of high-risk newborns was cost-effective.
Therefore, this type of low-cost intervention after birth (first six months) reduce the incidence of the disease and it is
possible that fewer patients will require more expensive therapy in the future.
The most cost-effective topical therapy are topical corticosteroids, and a cost-utility analysis has shown that topical
corticosteroids are more cost-effective over calcineurin inhibitors (pimecrolymus). If non-pharmacological measures and
topical therapy prove unsuccessful, cyclosporin A or UVAB phototherapy is administered. Cyclosporin A compares
favorably with UVAB in term of cost-effectiveness because of time-consuming nature of UVAB phototherapy. The newest
group of drugs in treatment of atopic dermatitis are biological drugs. Economic evaluation of dupilumab versus supportive
therapy (emollients) reported that dupilumab is cost-effective at an annual price range of 29000-40000$ at the 100000-
150000$/QALY threshold range.

• Keywords: atopijski dermatitis; farmakoekonomika; trošak liječenja; trošak bolesti
• Keywords (english): atopic dermatitis; pharmacoeconomy; treatment; cost of illnes; cost of treatment
• Language: croatian
• URN:NBN: urn:nbn:hr:163:525960
• Study programme: Title: Pharmacy; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra farmacije (magistar/magistra farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-02-21 13:17:55