Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study)
Authors: M. B. G. Koek, V. Sigurdsson, H. van Weelden, P. H. A. Steegmans, C. A. F. M. Bruijnzeel-Koomen, E. Buskens
Journal: BMJ (2010)

<b>Objective</b> To assess the costs and cost effectiveness of phototherapy with ultraviolet B light provided at home compared with outpatient ultraviolet B phototherapy for psoriasis. <b>Design</b> Cost utility, cost effectiveness, and cost minimisation analyses performed alongside a pragmatic randomised clinical trial (the PLUTO study) at the end of phototherapy (mean 17.6 weeks) and at one year after the end of phototherapy (mean 68.4 weeks). <b>Setting</b> Secondary care, provided by a dermatologist in the Netherlands. <b>Participants</b> 196 adults with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy were recruited from the dermatology departments of 14 hospitals and were followed until the end of phototherapy. From the end of phototherapy onwards, follow-up was continued for an unselected, consecutive group of 105 patients for one year after end of phototherapy. <b>Interventions</b> Ultraviolet B phototherapy provided at home (intervention) and conventional outpatient ultraviolet B phototherapy (control) in a setting reflecting routine practice in the Netherlands. Both treatments used narrowband ultraviolet B lamps (TL-01). <b>Main outcome measures</b> Total costs to society, quality adjusted life years (QALYs) as calculated using utilities measured by the EQ-5D questionnaire, and the number of days with a relevant treatment effect (≥50% improvement of the baseline self administered psoriasis area and severity index (SAPASI)). <b>Results</b> Home phototherapy is at least as effective and safe as outpatient phototherapy, therefore allowing cost minimisation analyses (simply comparing costs). The average total costs by the end of phototherapy were €800 for home treatment and €752 for outpatient treatment, showing an incremental cost per patient of €48 (95% CI €−77 to €174). The average total costs by one year after the end of phototherapy were €1272 and €1148 respectively (difference €124, 95% CI €−155 to €403). Cost utility analyses revealed that patients experienced equal health benefits—that is, a gain of 0.296 versus 0.291 QALY (home <i>v</i> outpatient) by the end of phototherapy (difference 0.0052, −0.0244 to 0.0348) and 1.153 versus 1.126 QALY by one year after the end of phototherapy (difference 0.0267, −0.024 to 0.078). Incremental costs per QALY gained were €9276 and €4646 respectively, both amounts well below the normally accepted standard of €20 000 per QALY. Cost effectiveness analyses indicated that the mean number of days with a relevant treatment effect was 42.4 versus 55.3 by the end of phototherapy (difference −12.9, −23.4 to −2.4). By one year after the end of phototherapy the number of days with a relevant treatment effect were 216.5 and 210.4 respectively (6.1, −41.1 to 53.2), yielding an incremental cost of €20 per additional day with a relevant treatment effect. <b>Conclusions</b> Home ultraviolet B phototherapy for psoriasis is not more expensive than phototherapy in an outpatient setting and proved to be cost effective. As both treatments are at least equally effective and patients express a preference for home treatment, the authors conclude that home phototherapy should be the primary treatment option for patients who are eligible for phototherapy with ultraviolet B light. <b>Trial registration</b> Current Controlled Trials ISRCTN83025173 and Clinicaltrials.gov NCT00150930