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R.J.B. Driessen, E.M.G.J. De Jong, M.A. De Rie, G.W. Salemink, P.C.M. Van De Kerkhof, Analysis of 3‐year national reimbursement application data on etanercept and efalizumab for psoriasis, British Journal of Dermatology, Volume 159, Issue 3, 1 September 2008, Pages 760–761, https://doi.org/10.1111/j.1365-2133.2008.08729.x
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Conflicts of interest: none declared.
Sir, As a consequence of the expense of biological therapies, patients need to fulfil specific criteria to obtain approval for reimbursement in many countries. In the Netherlands, patients with psoriasis are considered for reimbursement of the cost of treatment with etanercept or efalizumab if they are unresponsive, intolerant or have contraindications to phototherapy, ciclosporin and methotrexate. Furthermore, a minimum Psoriasis Area and Severity Index (PASI)1 of 10 is required at the time of screening. After 12 weeks of therapy, a PASI reduction of at least 50% (PASI 50) is necessary to get approval for long‐term treatment and reimbursement. Evaluation of these criteria in the Netherlands occurs centrally by a subcommittee of an independent foundation (National Evaluation of Applications of Drugs, LABAG). This committee is appointed by health insurance companies and comprises representatives of dermatologists, health insurance companies and the government.
We performed an analysis to evaluate 3‐year Dutch reimbursement application data regarding treatment of psoriasis with etanercept or efalizumab. From January 2005 to January 2008, 2306 application forms were received by LABAG. These concerned 1327 initial treatment applications (etanercept 1014, efalizumab 313) and 1197 patients. As the estimated number of persons with psoriasis in the Netherlands is 300 000, this is only 0·4% of the Dutch psoriasis population. A request for etanercept was made for 884 patients, compared with 183 patients with a request for efalizumab and 130 patients with a request for both etanercept and efalizumab. In the last group, the first applied therapy was efalizumab in 62·3% of cases.
