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  1. Question
  2. The task is the following: Identify what you believe are the key strengths and weaknesses of the assessment of cost-effectiveness in your selected appraisals
    explain briefly why they are strengths or weaknesses.
    The two selected apraisals are for 1) Dimethyl Fumarate 2)Secukinumab

    The suggested structure is provided in the file “Structure and instructions”.
    I will send you via email the documents of the two apraisals. Please do not hesitate to contact me for any other detail

    There are many different ways to approach this task, however, it is likely that you will need to consider most (if not all) of the following aspects:
    • type of modelling and structure of the model
    • nature and source of the clinical parameters (used in the economic modelling)
    • measurement and valuation of health effects
    • cost and healthcare resource use
    • base-case and sensitivity analyses
    • sub-group analyses
    The question concerns the economic model and the assessment of cost-effectiveness, and thus it is not appropriate to evaluate the evidence regarding clinical effectiveness (unless it is directly relevant to explaining how cost-effectiveness has been estimated).




Subject Nursing Pages 3 Style APA


Health Economics: Critical Review of Two Economic Evaluations for Plaque Psoriasis





Use a network meta-analysis with a PASI 75 response.

The use of the Markov state transition model provided sufficient information.

The models used are vital because they offer information about the costs of each treatment approach during both individual stages of treatment and the combined cost making it easy for comparison.

High affinity and fully human monoclonal antibody

Economic parameters for the model were sourced from comparative analysis of different treatment approves.

The comparison approaches make it easier to identify any finite cost differences and evaluate the effect of each treatment approach on the cost of the whole exercise.


The presence of a ten-year horizon.

Use of a lifetime horizon

 The Horizon is advantageous in enabling both patients and physicians to compare the cost of treatment for an extended period and not just a single visit to a healthcare facility.

Biological treatments are appropriate and supported by the model

Estimation of the procedures cost-effective to individuals with severe psoriasis and whom biologicals or apremilast is an option

The approach extended the coverage of the assessment to other treatment approaches thereby giving patients and physicians a chance to make better economic decisions on which approach to select.




Short time horizon probably led to overestimated

The lifetime horizon was an assumption, not a calculated estimate.

The horizon being an assumption does not cater for any unplanned changes in the cost of care.

Incremental cost-effectiveness ratios (ICERs) because secukinumab delayed

Varying treatment-specific stopping rate between 20 and 24%

The varying rates mean that overall cost estimations might vary if a different stopping rate is used instead of the one projected. Moreover, it fails to account for patients stopping the treatment due to adverse effects of the medications, especially after 16 weeks.

The health economic model failed to represent established and proper clinical practice for treating severe psoriasis

Progression to more expensive, less effective best supportive care treatments.

Variation in cost estimates relating to those who do not respond to treatment. Cost varies between £121 and £225

The aspect makes it difficult to determine the exact amount of cost that will be incurred in case of not responding to early treatment.



Lack of Generic preference-based quality-of-life evidence, which compares dimethyl fumigate
with apremilast and biologicals.

Therefore, the estimate does not offer the values relating to the quality of life when using the treatments. Therefore, the approach may be cost-effective but fail to ensure proper life quality hence leading to other expenses.


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