moderate-to-severe psoriasis who had inadequate response to a biologic therapy, the addition of Cal/BD foam to the biologic significantly improved PGA, BSA, and PGAxBSA at weeks 4 and 16 compared with baseline (Table 6).20 Response was rapid, with 76% of patients reaching the National Psoriasis Foundation’s treat-to-target goal of BSA ≤1% at week 4 compared with 12% at baseline (P<.001). These results suggest that adding Cal/BD foam to either apremilast or a biologic can confer quick and lasting benefits in patients with beyond-mild psoriasis.
Cost-Effectiveness
The use of Cal/BD foam in patients conventionally treated with biologic or oral medication has the potential to significantly reduce the cost of therapy. The cost per PASI75 response of Cal/ BD foam ($3770) in moderate psoriasis has been estimated to be more than 17-fold lower than that of apremilast ($66,671).33,34 In the setting of adjunctive therapy, the addition of Cal/BD foam to remove residual disease in patients receiving biologic therapy was estimated to substantially reduce treatment cost compared with either dose escalation or switching to another biologic agent (Table 7).35 These calculations suggest that adding Cal/BD foam to the treatment options for beyond-mild psoriasis would be associated with significant cost savings. In a budget impact model of moderate-to-severe psoriasis in a hypothetical US healthcare plan of 1 million plan lives, formulary adoption of Cal/BD foam was estimated to reduce the annual costs of treatment by more than $36 million and the per-member permonth cost by $3.00 (Table 8).9
Practical Recommendations for Managing Beyond-Mild Psoriasis With Topical Agents
It has been estimated that ~32% of insured patients in the United States with moderate or severe psoriasis are not currently being treated.36 Adverse effects, lack of response, and cost are among the most common reasons why patients discontinue treatment.37,38 In psoriasis, for which there are a limited number of options, finding the optimal management strategy requires that all avenues of treatment, topical, oral, or biologic, be considered. As the data described in this review have demonstrated, topical therapy with Cal/BD foam is potentially
