The issue
Psoriasis is a chronic inflammatory disease of the skin and joints. Patients often suffer from social stigmatisation and reduced health-related quality of life. Up to 30 per cent of people with psoriasis develop psoriatic arthritis, which causes pain and swelling of the joints and, if left untreated, can cause irreversible joint damage.
The National Institute for Health and Care Excellence (NICE) decides which treatments the National Health Service (NHS) in England should provide. NICE makes these decisions based on the best evidence on the effectiveness and cost-effectiveness of the treatments available at the time.
The research
Researchers from two York Departments (the Centre for Health Economics and the Centre for Reviews and Dissemination) carried out research to help NICE decide which treatments to recommend for patients with psoriasis and psoriatic arthritis.
This included 15 different assessments done between 2014 and 2020 involving three distinct but linked types of research:
- Extensive review and evaluation of existing research studies on the effectiveness and cost-effectiveness of the different treatment options.
- Combining the data from studies identified by the review in ‘network meta-analysis’ which brings together evidence from different sources into a single estimate of the effectiveness of new therapies compared to existing treatments.
- Developing a mathematical decision model to estimate the impact of the different treatments on quality of life and cost-effectiveness.
This research has often been at the cutting edge of new methods including the first use of a network meta-analysis to inform a recommendation by NICE.
The outcome
Informed by the 15 assessments by the York team, NICE national guidance for the treatment of psoriasis recommended 11 new treatments for use in the NHS. In the other cases it was concluded that the new treatments were not a cost-effective use of limited NHS resources. Subsequent prescriptions have reduced pain, improved mobility, day to day functioning, and quality of life for patients with psoriasis. This has led to an increase in the time these patients have spent with better levels of health-related quality of life, estimated as 4,100 additional quality-adjusted life-years between 2014-2020.
The research methods that were developed, tested, and applied through the research have led to more robust decisions being made by NICE and similar agencies around the world.