Open Access Open Badges Research article

Budget impact analysis of ustekinumab in the management of moderate to severe psoriasis in Greece

Georgia Avgerinou3, Ioannis Bassukas1, Georgios Chaidemenos2, Andreas Katsampas3, Marita Kosmadaki3, Hara Kousoulakou8*, Athanasios Petridis1, Brad Schenkel9, Dimitrios Sotiriadis4, Theofanis Spiliopoulos5, Panagiotis Stavropoulos3, Evgenia Toumpi6 and Loukas Xaplanteris7

Author affiliations

1 Department of Skin and Venereal Diseases, University of Ioannina, Ioannina, Greece

2 Department of Dermatology, Hospital for Skin and Venereal Diseases, Thessaloniki, Greece

3 Department of Dermatology, University of Athens, Hospital “A. Syggros”, Athens, Greece

4 Department of Dermatology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

5 Department of Dermatology, University of Patras, Patras, Greece

6 Department of Dermatology and Venereology, “Attikon” General University Hospital, Athens, Greece

7 Janssen Cilag Pharmaceutical SACI, Athens, Greece

8 PRMA Consulting Ltd, Hampshire, UK

9 Janssen Scientific Affairs, LLC, Horsham, PA, USA

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Citation and License

BMC Dermatology 2012, 12:10  doi:10.1186/1471-5945-12-10

Published: 25 July 2012



The purpose of this study was to estimate the annual and per-patient budget impact of the treatment of moderate to severe psoriasis in Greece before and after the introduction of ustekinumab.


A budget impact model was constructed from a national health system perspective to depict the clinical and economic aspects of psoriasis treatment over 5 years. The model included drug acquisition, monitoring, and administration costs for both the induction and maintenance years for patients in a treatment mix with etanercept, adalimumab, infliximab, with or without ustekinumab. It also considered the resource utilization for non-responders. Greek treatment patterns and resource utilization data were derived from 110 interviews with dermatologists conducted in February 2009 and evaluated by an expert panel of 18 key opinion leaders. Officially published sources were used to derive the unit costs. Costs of adverse events and indirect costs were excluded from the analysis. Treatment response was defined as the probability of achieving a PASI 50, PASI 75, or PASI 90 response, based on published clinical trial data.


The inclusion of ustekinumab in the biological treatment mix for moderate to severe psoriasis is predicted to lead to total per-patient savings of €443 and €900 in years 1 and 5 of its introduction, respectively. The cost savings were attributed to reduced administration costs, reduced hospitalizations for non-responders, and improved efficacy. These results were mainly driven by the low number of administrations required with ustekinumab over a 5 year treatment period (22 for ustekinumab, compared with 272 for etanercept, 131 for adalimumab, and 36 for infliximab).


The inclusion of ustekinumab in the treatment of moderate to severe psoriasis in Greece is anticipated to have short- and long-term health and economic benefits, both on an annual and per-patient basis.