***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Daivobet ® is a once-daily treatment of psoriasis vulgaris containing betamethasone dipropionate and calcipotriol in a new ointment vehicle . Objective : To assess the cost-effectiveness of once-daily treatment with Daivobet ( 4 weeks ) followed by calcipotriol ( 4 weeks ) compared to tacalcitol ( 8 weeks ) . Methods : Re source utilization was assessed within a double-blind 8-week clinical trial ( all treatments for psoriasis , adverse events and concomitant dermatological medication ) , estimated from the French societal perspective . Results : Total direct medical costs for psoriasis were comparable ( Daivobet : EUR 107.53 and tacalcitol EUR 113.50 ) despite a higher acquisition cost for Daivobet . The probability of ≧75 % reduction in the Psoriasis Area and Severity Index ( effectiveness criterion ) was 46.6 % with Daivobet and 13.9 % with tacalcitol at 4 weeks , and 44.6 and 23.8 % , respectively , at 8 weeks ( both : p < 0.001 ) . Over 8 weeks , Daivobet was almost twice as cost-effective  as tacalcitol ( EUR 241.22 per successful treatment vs. EUR 476.70 ) ; this result was robust to sensitivity assumptions . Conclusion : Daivobet  is more effective and less costly  than tacalcitol for treating psoriasis BACKGROUND Because health care re sources are limited , therapeutic regimens should be assessed for their relative costs and effectiveness . OBJECTIVE We assessed cost-effectiveness for treating psoriasis using two strategies : one consisted principally of methotrexate and the other was principally a rotational schedule of modified cyclosporine ( Neoral ) with methotrexate . METHODS We performed a cost-effectiveness analysis using a computerized decision analytic model of simulated patients with moderate to severe psoriasis . Patients were r and omly assigned to receive treatment with one of the two strategies .  Direct costs included acquisition of medications , laboratory and physician fees , and costs of treating side effects . Because of uncertainty regarding rates of clearing of psoriasis , the relative efficacy of methotrexate and cyclosporine was varied over a wide range in a sensitivity analysis . RESULTS In the base case over a 10-year treatment period , the methotrexate strategy cost $ 33,000 and provided approximately 2 years clear of psoriasis compared with $ 38,000 and approximately 4 years clear of psoriasis for the rotational strategy . When the relative effectiveness of cyclosporine to methotrexate in clearing psoriasis varied from approximately 1 to 20 , the rotational strategy cost from $ 4100 to $ 2700 per incremental clear year . CONCLUSION In selecting therapies for psoriasis patients , both costs and effectiveness should be considered . In this simulation , patients could obtain additional periods clear of psoriasis at an incremental cost by using cyclosporine in rotation with methotrexate . If even a small utility gain accompanies the complete clearing of psoriasis , such a strategy may be a worthwhile investment of re sources comparable to other healthcare interventions Psoralen + ultraviolet A ( PUVA ) therapy is an established modality for psoriasis . As India is a tropical country that has good availability of natural sunlight psoralen + sunlight ( PUVAsol ) may be a more convenient option . To compare the efficacy and cost-effectiveness of PUVA versus PUVAsol in chronic plaque psoriasis . Cases of chronic plaque psoriasis with body surface area ≥10 % or Psoriasis Area and Severity Index ( PASI ) ≥10 , excluding erythrodermic or pustular psoriasis , were r and omized to receive either  PUVA or PUVAsol , with endpoint being the achievement of PASI 90 or completion of 12 weeks treatment , whichever is earlier . Cost analysis was also undertaken . Thirty-six cases ( 16 in PUVA and 20 in PUVAsol group ) completed treatment . In the PUVA group , 15 cases ( 93.75 % ) responded to therapy while in the PUVAsol group , 15 ( 75 % ) responded ( P = 0.29 ) . Mean baseline PASI in the PUVA and PUVAsol groups was 16 and 14.4 , respectively , and at endpoint was 1.62 and 3.77 . There was a significantly greater reduction in PASI in the PUVA group at 2 and 4 weeks but at 8 and 12 weeks and endpoint , it was comparable . Treatment failure occurred in 6.25 % and 25 % of cases respectively ( P = 0.29 ) . Side effects were higher with  PUVA . Total cost of therapy was significantly higher in the PUVA group ( P = 0.002 ) . Cost-effectiveness ratio was US$ 0.72 with PUVA and US$ 0.37 with PUVAsol . Both PUVA and PUVAsol were equally efficacious , with PUVAsol being twice as cost effective . Hence , PUVAsol may be recommended as treatment for psoriasis in a developing economy such as India Background This study was part of a large national cost‐effectiveness analysis , and was funded by the National Fund for Investigational Medicine of the Health Care Insurance Board . Objective To assess the costs and cost effectiveness of phototherapy with ultraviolet B light provided at home compared with outpatient ultraviolet B phototherapy for psoriasis . Design Cost utility , cost effectiveness , and cost minimisation analyses performed alongside a pragmatic r and omised clinical trial ( the PLUTO study ) at the end of phototherapy ( mean 17.6 weeks ) and at one year after the end of phototherapy ( mean 68.4 weeks ) . Setting Secondary care , provided by a dermatologist in the Netherl and s. Participants 196 adults with psoriasis who were clinical ly eligible for narrowb and ( TL-01 ) ultraviolet B phototherapy were recruited from the dermatology departments of 14 hospitals and were followed until the end of phototherapy . From the end of phototherapy onwards , follow-up was continued for an unselected , consecutive group of 105 patients for one year after end of phototherapy . Interventions Ultraviolet B phototherapy provided at home ( intervention ) and conventional outpatient ultraviolet B phototherapy ( control ) in a setting reflecting routine practice in the Netherl and s. Both treatments used narrowb and ultraviolet B lamps ( TL-01 ) . Main outcome measures Total costs to society , quality adjusted life years ( QALYs ) as calculated using utilities measured by the EQ-5D question naire , and the number of days with a relevant treatment effect ( ≥50 % improvement of the baseline self administered psoriasis area and severity index ( SAPASI ) ) . Results Home phototherapy is at least as effective and safe as outpatient phototherapy , therefore allowing cost minimisation analyses ( simply comparing costs ) . The average total costs by the end of phototherapy were € 800 for home treatment and € 752 for outpatient treatment , showing an incremental cost per patient of € 48 ( 95 % CI € −77 to € 174 ) . The average total costs by one year after the end of phototherapy were € 1272 and € 1148 respectively ( difference € 124 , 95 % CI € −155 to € 403 ) . Cost utility analyses revealed that patients experienced equal health benefits —that is , a gain of 0.296 versus 0.291 QALY ( home v outpatient ) by the end of phototherapy ( difference 0.0052 , −0.0244 to 0.0348 ) and 1.153 versus 1.126 QALY by one year after the end of phototherapy ( difference 0.0267 , −0.024 to 0.078 ) . Incremental costs per QALY gained were € 9276 and € 4646 respectively , both amounts well below the normally accepted st and ard of € 20 000 per QALY . Cost effectiveness analyses indicated that the mean number of days with a relevant treatment effect was 42.4 versus 55.3 by the end of phototherapy ( difference −12.9 , −23.4 to −2.4 ) . By one year after the end of phototherapy the number of days with a relevant treatment effect were 216.5 and 210.4 respectively ( 6.1 , −41.1 to 53.2 ) , yielding an incremental cost of € 20 per additional day with a relevant treatment effect . Conclusions Home ultraviolet B phototherapy for psoriasis is not more expensive than phototherapy in an outpatient setting and proved to be cost effective . As both treatments are at least equally effective and patients express a preference for home treatment , the authors conclude that home phototherapy should be the primary treatment option for patients who are eligible for phototherapy with ultraviolet B light .  Trial registration Current Controlled Trials IS RCT N83025173 and Clinical trials.gov OBJECTIVE Psoriasis is one of the most common forms of chronic dermatitis , affecting 2 - 3 % of the worldwide population . It has a serious effect on the way patients perceive themselves and others , thereby prejudicing their quality of life and giving rise to a significant deterioration in their psycho-physical well-being ; it also poses greater difficulties for them in leading a normal social life , including their ability to conduct a normal working life . All the above-mentioned issues imply a cost for the society . This study proposes to evaluate the impact on societal costs for the treatment of chronic plaque psoriasis with biologics ( etanercept , infliximab and adalimumab ) in the Italian clinical practice . METHOD A prospect i ve observational study has been conducted in 12 specialized centres of the Psocare network , located throughout Italy .  Direct and indirect costs ( as well as the health-related quality of life of patients with plaque psoriasis undergoing biologic treatments ) have been estimated , while the societal impact has been determined using a cost-utility approach . RESULTS Non-medical and indirect costs account for as much as 44.97 % of the total cost prior to treatment and to 6.59 % after treatment , with an overall 71.38 % decrease . Adopting a societal perspective in the actual clinical practice of the Italian participating centres , the ICER of biologic therapies for treating plaque psoriasis amounted to € 18634.40 per QALY gained -- a value far from the € 28656.30 obtained by adopting a third-party payer perspective . CONCLUSION Our study confirms that chronic psoriasis subjects patients to a considerable burden , together with their families and caregivers , stressing how important it is to take the societal perspective into consideration during the appraisal process . Besides , using data derived from Italian actual practice , treatment with biologics shows a noteworthy benefit in social terms Abstract Objective : To assess the cost effectiveness of tapered versus abrupt discontinuation of a microemulsion formulation of cyclosporin in patients with chronic plaque psoriasis . Methods : A cost-effectiveness analysis was performed in parallel with a nonblind , multicentre , international clinical trial of the safety and efficacy of intermittent short courses of cyclosporin . Direct and indirect costs were considered within a 1-year period following r and omisation . Patients : Patients with chronic plaque psoriasis inadequately controlled with topical treatment . Study perspective : The study was conducted froma societal perspective and was performed using data from Canada , Spain , Turkey and the UK . Main outcomes measures : The health outcome used was the total number of systemic therapy-free days ( STFDs ) over the first year . The mean incremental cost-effectiveness ratio ( ICER ) was determined by dividing the differences in average cost per patient by the differences in average STFDs per patient . Results : The overall ICER was dominant because tapered discontinuation was associated with both lower costs and improved efficacy in comparison with abrupt discontinuation . Further analyses showed that tapered discontinuation was a cost-effective alternative to abrupt discontinuation therapy , even when a conservative definition for cost effectiveness was adopted . Conclusion : This cost-effectiveness analysis demonstrated that tapering cyclosporin wasmore cost effective than abruptly stopping cyclosporin in patients with chronic plaque psoriasis Background : Psoriasis vulgaris requires lifelong treatment associated with considerable health cost . Studies showed that a combination of a steroid and a vitamin D3 analogue is more effective than both compounds in monotherapy . Objective : To determine the cost-effectiveness of a fix calcipotriol/betamethasone combination ( Daivobet ® /Dovobet ® /Taclonex ® ) compared to a morning/evening non-fix calcipotriol/betamethasone combination in psoriasis treatment . Methods : A Markov model ( discrete-time stochastic process based on transitions between health states ) with 2 treatment arms ( Daivobet/Dovobet/Taclonex vs. non-fix calcipotriol/betamethasone )  over a 48-week time period was developed . The effectiveness criterion was the number of days with clearance or marked improvement . Clinical and health re source utilisation data were derived from r and omised studies . Results : Treatment with Daivobet/Dovobet/Taclonex showed a higher cost-effectiveness compared to the non-fix combination , even when assuming a maximum compliance for the twice daily non-fix combination and varying the effectiveness of Daivobet/Dovobet/Taclonex by 10 % . Conclusion : Ps 
    Output:
    
The majority of health economic studies is focusing on the direct medical and non-medical costs without consideration of productivity losses .
Given the setting , compared treatments , and study conditions , different results can be found for medical decision-making .