Psoriasis causes significant economic burden to patients

Economic burden of psoriasis in Southern Iran in 2022

INTRODUCTION

Psoriasis is a common, chronic, and non-contagious skin disease that has no known cause or treatment. Various medical costs for skin disorders, including psoriasis, can be expensive and lifelong. The purpose of the present study was to determine the economic burden of psoriasis in patients admitted to general hospitals affiliated with Shiraz University of Medical Sciences, Iran in 2022.

MATERIALS AND METHODS

This research was a descriptive, cross-sectional, cost of illness study from a societal perspective. All psoriasis patients (N = 118) admitted to the hospitals affiliated with Shiraz University of Medical Sciences in 2022 were examined. 7 participants refused to cooperate and were excluded from the study and, the information of 111 patients was collected. A researcher-made data collection form was used to collect data. A prevalence-based approach was used to prepare cost data, and the costing approach was bottom-up. The productivity lost due to the absenteeism of patients and their companions was estimated using the human capital approach. Microsoft Excel ® 2016 was applied to analyze the data.

RESULTS

The mean annual cost per psoriasis patient was estimated to be US$ 30,374.21. Its highest and lowest share was related to direct medical costs (88.61%), direct non-medical costs (7.3%) and indirect costs (4.09%), respectively. Also, the highest mean direct medical, direct non-medical, and indirect costs per patient were related to those of medicine (93.11%), transportation (51.65%), and absenteeism of the patients' companions due to patient care (71.73%).

CONCLUSION

Considering that the major contributor in the direct medical cost of treating psoriasis patients was related to medicine, designing appropriate mechanisms for insurance coverage, and allocating government subsidies for the purchase of medicine, are suggested. The result of the current study has important implications for policymakers in developing guidelines for early diagnosis of this disease and reducing the health economic burden.

Treatment patterns of systemic drug use in Japanese patients with plaque psoriasis: A retrospective chart review

Plaque psoriasis (PsO) is a chronic immune-mediated inflammatory disease with skin lesions accompanied by an inflammation-related comorbidity risk. The development of various oral drugs and biologics for PsO has provided increasing systemic treatment options for patients with PsO, and the guidance regarding the use of biologics and PsO treatment schemes are widespread in Japan. However, no comprehensive guidelines regarding systemic drug use are available, and the current treatment patterns of systemic drugs for PsO in Japan remain unclear. We conducted a retrospective chart review to clarify the current treatment patterns of systemic drugs for PsO. We enrolled 114 patients who started systemic drugs for PsO between January 2017 and December 2020 at four institutes, with a mean follow-up of 37.2 months. The mean disease duration was 7.8 (standard deviation 9.5) years at the systemic drug initiation. Of all the patients, 78.1% started with oral drugs (phosphodiesterase [PDE] 4 inhibitors 56.1%. calcineurin inhibitors 14.0%. vitamin A derivatives 7.9%), whereas 21.9% started with biologics (interleukin [IL]-17 inhibitors 9.6%. tumor necrosis factor inhibitors 7.0%. IL-23 inhibitors 3.5%. IL-12/23 inhibitors 1.8%). Oral drugs had shorter drug persistence than biologics: the 12-month persistence of the oral drugs vitamin A derivative, calcineurin inhibitor, and PDE4 inhibitor, was 35.5%, 25.8%, and 60.1%, respectively, compared with that of the biologics IL-23 and IL-17 inhibitors, which was 85.6% and 84.7%, respectively. During the study period, the incidence of treatment changes was 59.1/100 patient-years. Lack of efficacy was the most common reason for treatment changes from monotherapy (34.1%). This retrospective medical chart review allowed us to understand the real-world, long-term treatment patterns of systemic drugs for PsO and the relationships between the reasons for treatment changes and subsequent treatment selection, indicating that there is still room for improvement in the appropriate use of systemic drugs for PsO in Japan.

PsoBarrier EU study: a Multicentre, Cross-sectional Survey Investigating the Quality of Psoriasis Care in Four European Countries

Enhanced treatment options for psoriasis and growing use of guidelines increased the potential to better quality of psoriasis care in Europe. The aim of the PsoBarrier EU study is to compare the quality and processes of psoriasis care in four European countries with different healthcare systems, based on validated quality indicators. This cross-sectional survey was conducted in dermatology centres in Denmark, Germany, Poland and Spain on 1,304 patients, using standardized patient and physician questionnaires. Measured by quality of psoriasis care indicators, patients in Poland had the most critical outcomes, such as the highest disease severity (Psoriasis Area and Severity Index; PASI) and lowest health-related quality of life (Dermatology Life Quality Index; DLQI). This indicates differences in psoriasis care, with Polish participants experiencing more severe psoriasis and its consequences. Differences in the healthcare systems, which create barriers to accessing treatments, could explain variations in quality of care.

Comorbidities and Medication Use in Finnish Patients with Psoriasis: A Population-Based Registry Study

Therapeutic options for psoriasis vulgaris have changed during recent decades with the introduction of biologics. Few nationwide studies are available on psoriasis treatment patterns, and those from Finland predate the use of biologics. The aim of this retrospective, population-based registry study was to identify patients with psoriasis vulgaris and their treatment patterns in the secondary care setting in Finland. The study cohort included 41,456 adults with a diagnosis of psoriasis vulgaris in the public secondary healthcare setting from 2012 through 2018. Data on comorbidities, pharmacotherapy, and phototherapy were collected from nationwide healthcare and drug registries. Patients in the cohort had a wide range of comorbidities, with 14.9% having psoriatic arthritis. Treatment was based largely on topical and conventional systemic medications. Conventional medications were used by 28.9% of patients, and methotrexate was the most common option (20.9%). Biologics were used by 7.3% of patients, mostly as second- and third-line treatment. The use of conventional systemic medications, topical treatments, and phototherapy decreased after the initiation of biologics. This study of psoriasis vulgaris in Finland provides a framework for the development of future care practices.

The Societal Economic Impact of Secukinumab in First-Line Treatment of Moderate to Severe Plaque Psoriasis in Germany: An Open-Cohort Simulation

OBJECTIVES

Moderate to severe plaque psoriasis is a chronic inflammatory disease. In Germany, guidelines recommend fumaric acid esters (FAEs) as first-line systemic treatment. Despite treatment with FAEs, disease burden remains high in Germany. Secukinumab, a fully human monoclonal antibody, has demonstrated greater efficacy and safety than FAEs in the PRIME trial. The aim of the current study, hence, is to quantify the potential societal economic impact of secukinumab in systemic treatment-naïve patients with moderate to severe plaque psoriasis in Germany.

METHODS

We employed a semi-Markov model to capture health gains at an individual level and a dynamic population model to extrapolate the findings in the population of interest. We quantified the health outcomes in two scenarios: (i) patients receiving secukinumab and (ii) patients receiving FAEs. Using estimates on change in work productivity and societal economic parameters, we translated the health outcomes into paid and unpaid economic gains. We used gross value added (GVA) to value these gains and calculated the macroeconomic indirect and induced value-chain effects.

RESULTS

Our calculations show that patients treated with secukinumab spend on average 94% of their time in Psoriasis Area and Severity Index (PASI) ≥ 75 state compared with 80% for patients in the FAEs scenario. When assuming that FAEs are the sole comparator to secukinumab, this difference could lead to 4.3 million active hours gained until 2030. These gained hours translate to a total societal economic impact of €308 million till 2030 for the whole patient population in GVA terms.

CONCLUSION

This study demonstrated that using secukinumab instead of FAEs in moderate to severe plaque psoriasis could lead to substantial macroeconomic GVA gains.

Serum Levels of miR-146a in Patients with Psoriasis

BACKGROUND

Psoriasis is an immune-mediated disease with interactions between genetic and environmental factors. An increasing number of studies are demonstrating the importance of microRNAs (miRNAs) in the pathogenesis of psoriasis. miR-146a, a dominant negative regulator of inflammation, has been consistently reported as overexpressed in the skin and peripheral blood mononuclear cells (PBMCs) of patients with psoriasis. Expression and/or function of this miRNA is highly influenced by genetic variations, some of which have already been associated with susceptibility to psoriasis.

OBJECTIVE

We sought to study the importance of miR-146a in patients with moderate-to-severe psoriasis and to understand the impact of rs57095329 and rs2910164 polymorphisms in a psoriatic Portuguese population.

METHODS

miR-146a circulating levels were quantified using molecular biology techniques in 99 patients with moderate-to-severe psoriasis (35 female, 64 male; age 47.4 ± 10.9 years) and 78 healthy individuals (52 female, 26 male; age 42.4 ± 10.1 years). miRNA expression was correlated with clinicopathological features as well as with genetic data such as the presence of human leukocyte antigen (HLA)-C*0602 allele and two miR-146a polymorphisms (rs2910164 and rs57095329).

RESULTS

miR-146a serum levels were 3.7-fold higher in patients with psoriasis than in controls (p < 0.0001, area under the curve [AUC] 0.75; 95% confidence interval [CI] 0.66-0.83). Of note, miR-146a circulating levels positively correlated with Psoriasis Area and Severity Index (p < 0.05) and body surface area (p < 0.05) indexes. No variations in miR-146a levels were observed with rs2910164 and rs57095329 genotypes.

CONCLUSION

Circulating miR-146a levels were upregulated in patients with psoriasis, especially in those with active disease. To the best of our knowledge, this is the largest study with a homogenous psoriasis population, and our data could shed light on the pathogenesis of psoriasis, paving the way for new avenues for disease treatment.

Work/study productivity gain and associated indirect cost savings with guselkumab compared with adalimumab in moderate-to-severe psoriasis: results from the VOYAGE 1 study

Background: Work productivity loss (WPL) is a major contributor to the indirect costs of psoriasis. Newer biologic therapies are effective at reducing disease symptoms and improving quality of life, but their impact on WPL and associated indirect cost savings compared to previously approved biologic therapies is largely unknown.Objectives: To compare the effects of guselkumab and adalimumab on WPL and associated indirect cost savings in patients with moderate-to-severe psoriasis.Methods: Using data from the VOYAGE 1 (NCT02207231) trial, improvements from baseline in Dermatology Life Quality Index (DLQI) work/study domain scores were compared for patients receiving guselkumab or adalimumab at 24 and 48 weeks of treatment. Improvements in WPL and associated cost savings were calculated using a previously established DLQI-WPL algorithm.Results: Among patients who could not work/study at baseline (DLQI work/study domain score = 3), a significantly greater proportion of guselkumab-treated patients could work/study without problems (DLQI work/study domain score = 0) than adalimumab-treated patients at Weeks 24 and 48. Improvements from baseline in WPL and associated cost savings were greater with guselkumab than with adalimumab at Week 48.Conclusions: Guselkumab was superior to adalimumab for improvement in WPL and associated indirect cost savings, and its use may reduce the economic burden of psoriasis.

Incremental Costs for Psoriasis and Psoriatic Arthritis in a Population-based Cohort in Southern Sweden: Is It All Psoriasis-attributable Morbidity?

Objective.

To estimate incremental costs for patients with psoriasis/psoriatic arthritis (PsO/PsA) compared to population-based referents free from PsO/PsA and estimate costs attributable specifically to PsO/PsA.

Methods.

Patients were identified by International Classification of Diseases, 10th ed., codes for PsO/PsA using information from 1998 to 2007 in the Skåne Healthcare Register, covering healthcare use for the population of the Skåne region of Sweden. For each patient, 3 population-based referents were selected. Data were retrieved from Swedish registers on healthcare, drugs, and productivity loss. The human capital method was used to value productivity losses. Mean annual costs for 2008 to 2011 were assessed from a societal perspective.

Results.

We identified 15,283 patients fulfilling the inclusion criteria for PsO [n = 12,562, 50% women, mean age (SD) 52 (21) yrs] or PsA [n = 2721, 56% women, mean age 54 (16) yrs] and included 45,849 referents. Mean annual cost per patient with PsO/PsA was 55% higher compared to referents: €10,500 vs €6700. The cost was 97% higher for PsA compared to PsO. Costs due to productivity losses represented the largest share of total costs, ranging from 52% for PsO to 60% for PsA. Biological drug costs represented 10% of the costs for PsA and 1.6% for PsO. The proportion of cost identified as attributable to PsO/PsA problems was greatest among the patients with PsA (drug costs 71% and healthcare costs 31%).

Conclusion.

Annual mean incremental societal cost per patient was highest for PsA, mainly because of productivity losses and biological treatment. A minor fraction of the costs were identified as attributable to PsO/PsA specifically, indicating an increased morbidity in these patients that needs to be further investigated.