The Cost Effectiveness of Tapered versus Abrupt Discontinuation of Oral Cyclosporin Microemulsion for the Treatment of Psoriasis

Objective: To assess the cost effectiveness of tapered versus abrupt discontinuation of a microemulsion formulation of cyclosporin in patients with chronic plaque psoriasis. Methods: A cost-effectiveness analysis was performed in parallel with a nonblind, multicentre, international clinical trial of the safety and efficacy of intermittent short courses of cyclosporin. Direct and indirect costs were considered within a 1-year period following randomisation. Patients: Patients with chronic plaque psoriasis inadequately controlled with topical treatment. Study perspective: The study was conducted from a societal perspective and was performed using data from Canada, Spain, Turkey and the UK. Main outcomes measures: The health outcome used was the total number of systemic therapy-free days (STFDs) over the first year. The mean incremental cost-effectiveness ratio (ICER) was determined by dividing the differences in average cost per patient by the differences in average STFDs per patient. Results: The overall ICER was dominant because tapered discontinuation was associated with both lower costs and improved efficacy in comparison with abrupt discontinuation. Further analyses showed that tapered discontinuation was a cost-effective alternative to abrupt discontinuation therapy, even when a conservative definition for cost effectiveness was adopted. Conclusion: This cost-effectiveness analysis demonstrated that tapering cyclosporin was more cost effective than abruptly stopping cyclosporin in patients with chronic plaque psoriasis.