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Hilhorst NT, Abatih E, Deprez E, Lambert JLW, Hoorens I. Determining patient value profiles in psoriasis. Exp Dermatol 2023; 32:1815-1822. [PMID: 37564000 DOI: 10.1111/exd.14906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/05/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Healthcare professionals (HCPs) should strive to create the maximum value for their patients in which value is defined as the patient-relevant health outcomes achieved per costs made. However, currently it remains difficult to determine which outcomes matter to an individual psoriasis patient. OBJECTIVE To define outcome profiles, or so called 'patient value profiles', within a cohort of psoriasis patients that can be translated to daily practice to increase value for the individual patient. METHODS Hierarchical clustering on principal components (HCPC) was used to identify groups of patients sharing the same profile within an outcome ranking exercise. Once the clusters were defined, their characterization was provided based on a V-test. In a final step, a multi-class decision tree (MDT) based on relevant socio-demographic and clinical variables was built to allocate patients to a cluster. RESULTS In the ranking exercise 120 patients participated. The median age was 50.0 (IQR 25.0) years and 36.7% were female. Median PASI score was 2.4 (IQR 5.2) and median duration of psoriasis was 17.0 (IQR 20.0) years. Primary treatment varied from topicals to biologicals. We found three distinct patient value profiles in this cohort (QoL, cost and treatment). A MDT was built which had an accuracy of 64%. CONCLUSION We found three distinct patient value profiles in a cohort of psoriasis patients and patients can be easily assigned to one of these profiles based on a MDT. HCPs can use these profiles to steer psoriasis management accordingly allowing for a more goal-orientated approach.
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Affiliation(s)
- N T Hilhorst
- Dermatology Research Unit, Ghent University, Ghent, Belgium
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - E Abatih
- Department of Applied Mathematics, Computer Sciences and Statistics, Ghent University, Ghent, Belgium
| | - E Deprez
- Dermatology Research Unit, Ghent University, Ghent, Belgium
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - J L W Lambert
- Dermatology Research Unit, Ghent University, Ghent, Belgium
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - I Hoorens
- Dermatology Research Unit, Ghent University, Ghent, Belgium
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
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Liu L, Lin NX, Yu YT, Wang SH, Wang J, Cai XC, Wang CX, Zhang M, Li X, Li B. Epidemiology of mental health comorbidity in patients with psoriasis: An analysis of trends from 1986 to 2019. Psychiatry Res 2023; 321:115078. [PMID: 36724650 DOI: 10.1016/j.psychres.2023.115078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND The prevalence of mental disorders such as depression, anxiety, and suicide has increased in patients with psoriasis, although no study has systematically analyzed the epidemiology worldwide. OBJECTIVE To explore the prevalence and incidence of psoriasis with comorbid mental disorders (i.e., depression, anxiety, and suicide). METHODS Five databases from establishment through May 2022 were searched. Stata SE 15.1 was used for the data analysis. Subgroup, meta-regression, and sensitivity analyses were used to evaluate the heterogeneity of pooled studies. RESULTS We evaluated 56 studies in our research. The prevalence of depression, anxiety, and suicide in adults with psoriasis was 20%, 21%, and 0.77%. Patients with psoriasis in North America had a higher prevalence of depression and suicide, whereas those in South America had a higher prevalence of anxiety. The incidence of depression, anxiety, and suicide was 42.1, 24.7, and 2.6 per 1000 person-years in adults with psoriasis, respectively. LIMITATIONS All of the included studies were published in Chinese and English, causing a degree of selection bias. CONCLUSION These findings demonstrate the incidence and prevalence of comorbid mental disorders in patients with psoriasis, which may raise awareness among physicians and patients regarding the mental problems associated with psoriasis.
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Affiliation(s)
- Liu Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Nai-Xuan Lin
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yuan-Ting Yu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Si-Han Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jiao Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Xiao-Ce Cai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Chun-Xiao Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Miao Zhang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Bin Li
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China; Department of Dermatology, Shanghai Skin Disease Hospital, Shanghai 200443, China.
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3
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Hensen B, Winkelmann C, Wacker FK, Vogt B, Dewald CLA, Neumann T. Identification of Relevant Attributes for Liver Cancer Therapies (IRALCT): a maximum-difference-scaling analysis. Sci Rep 2022; 12:19143. [PMID: 36351993 PMCID: PMC9646805 DOI: 10.1038/s41598-022-23097-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
The Identification of Relevant Attributes for Liver Cancer Therapies (IRALCT) project is intended to provide new insights into the relevant utility attributes regarding therapy choices for malignant primary and secondary liver tumors from the perspective of those who are involved in the decision-making process. It addresses the potential value of taking patients' expectations and preferences into account during the decision-making and, when possible, adapting therapies according to these preferences. Specifically, it is intended to identify the relevant clinical attributes that influence the patients', medical laymen's, and medical professionals' decisions and compare the three groups' preferences. We conducted maximum difference (MaxDiff) scaling among 261 participants (75 physicians, 97 patients with hepatic malignancies, and 89 medical laymen) to rank the importance of 14 attributes previously identified through a literature review. We evaluated the MaxDiff data using count analysis and hierarchical Bayes estimation (HB). Physicians, patients, and medical laymen assessed the same 7 attributes as the most important: probability (certainty) of a complete removal of the tumor, probability of reoccurrence of the disease, pathological evidence of tumor removal, possible complications during the medical intervention, welfare after the medical intervention, duration and intensity of the pain, and degree of difficulty of the medical intervention. The cumulative relative importance of these 7 attributes was 88.3%. Our results show that the physicians', patients', and medical laymen's preferences were very similar and stable.Trial registration DRKS-ID of the study: DRKS00013304, Date of Registration in DRKS: 2017/11/16.
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Affiliation(s)
- Bennet Hensen
- grid.5807.a0000 0001 1018 4307Research Campus STIMULATE, Otto von Guericke University Magdeburg, Otto-Hahn-Straße 2, 39106 Magdeburg, Germany ,grid.10423.340000 0000 9529 9877Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Carolin Winkelmann
- grid.5807.a0000 0001 1018 4307Research Campus STIMULATE, Otto von Guericke University Magdeburg, Otto-Hahn-Straße 2, 39106 Magdeburg, Germany ,grid.5807.a0000 0001 1018 4307Chair in Empirical Economics, Otto von Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Frank K. Wacker
- grid.5807.a0000 0001 1018 4307Research Campus STIMULATE, Otto von Guericke University Magdeburg, Otto-Hahn-Straße 2, 39106 Magdeburg, Germany ,grid.10423.340000 0000 9529 9877Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Bodo Vogt
- grid.5807.a0000 0001 1018 4307Research Campus STIMULATE, Otto von Guericke University Magdeburg, Otto-Hahn-Straße 2, 39106 Magdeburg, Germany ,grid.5807.a0000 0001 1018 4307Chair in Empirical Economics, Otto von Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany ,grid.5807.a0000 0001 1018 4307Chair in Health Economics, Institute of Social Medicine and Health Systems Research, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Cornelia L. A. Dewald
- grid.10423.340000 0000 9529 9877Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Thomas Neumann
- grid.5807.a0000 0001 1018 4307Research Campus STIMULATE, Otto von Guericke University Magdeburg, Otto-Hahn-Straße 2, 39106 Magdeburg, Germany ,grid.5807.a0000 0001 1018 4307Chair in Empirical Economics, Otto von Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany ,grid.5807.a0000 0001 1018 4307University Department of Neurology, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany ,grid.5836.80000 0001 2242 8751Chair in Health Services Research, School of Life Sciences, University of Siegen, Am Eichenhang 50, 57076 Siegen, Germany
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4
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Faverio K, Peitsch WK, Görig T, Schneider‐Burrus S, Benzel F, Goebeler M, Schummer P, Badran A, Schaarschmidt M, Harth W, Mössner R, Kromer C. Patient Preferences in Hidradenitis Suppurativa (APProach‐HS): a discrete choice experiment. J Dtsch Dermatol Ges 2022; 20:1441-1452. [DOI: 10.1111/ddg.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Kristin Faverio
- Department of Dermatology and Phlebology Vivantes Klinikum im Friedrichshain Berlin Germany
- Faculty of Medicine Charité – University Medicine Berlin Berlin Germany
| | - Wiebke K. Peitsch
- Department of Dermatology and Phlebology Vivantes Klinikum im Friedrichshain Berlin Germany
| | - Tatiana Görig
- Department of Medical Informatics Biometry and Epidemiology Friedrich‐Alexander‐University of Erlangen‐Nuremberg Erlangen Germany
| | | | - Friderike Benzel
- Department of Dermatology and Phlebology Vivantes Klinikum im Friedrichshain Berlin Germany
| | - Matthias Goebeler
- Department of Dermatology Venereology and Allergology University Hospital Würzburg Würzburg Germany
| | - Patrick Schummer
- Department of Dermatology Venereology and Allergology University Hospital Würzburg Würzburg Germany
| | - Alaa Badran
- Department of Dermatology Venereology and Allergology University Hospital Würzburg Würzburg Germany
| | - Marthe‐Lisa Schaarschmidt
- Department of Dermatology Venereology and Allergology University Medical Center Mannheim Heidelberg University Mannheim Germany
| | - Wolfgang Harth
- Department of Dermatology and Allergology Vivantes Klinikum Spandau Berlin Germany
| | - Rotraut Mössner
- Department of Dermatology Venereology and Allergology University Medical Center Göttingen Göttingen Germany
| | - Christian Kromer
- Department of Dermatology Venereology and Allergology University Medical Center Göttingen Göttingen Germany
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5
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Faverio K, Peitsch WK, Görig T, Schneider‐Burrus S, Benzel F, Goebeler M, Schummer P, Badran A, Schaarschmidt M, Harth W, Mössner R, Kromer C. Patientenpräferenzen bei Hidradenitis suppurativa (APProach‐HS): ein “Discrete‐Choice”‐Experiment. J Dtsch Dermatol Ges 2022; 20:1441-1454. [DOI: 10.1111/ddg.14886_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Kristin Faverio
- Klinik für Dermatologie und Phlebologie Vivantes Klinikum im Friedrichshain Berlin Deutschland
- Medizinische Fakultät Charité –Universitätsmedizin Berlin Deutschland
| | - Wiebke K. Peitsch
- Klinik für Dermatologie und Phlebologie Vivantes Klinikum im Friedrichshain Berlin Deutschland
| | - Tatiana Görig
- Institut für Medizininformatik Biometrie und Epidemiologie (IMBE) Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Deutschland
| | | | - Friderike Benzel
- Klinik für Dermatologie und Phlebologie Vivantes Klinikum im Friedrichshain Berlin Deutschland
| | - Matthias Goebeler
- Klinik und Poliklinik für Dermatologie Venerologie und Allergologie Universitätsklinikum Würzburg Würzburg Deutschland
| | - Patrick Schummer
- Klinik und Poliklinik für Dermatologie Venerologie und Allergologie Universitätsklinikum Würzburg Würzburg Deutschland
| | - Alaa Badran
- Klinik und Poliklinik für Dermatologie Venerologie und Allergologie Universitätsklinikum Würzburg Würzburg Deutschland
| | - Marthe‐Lisa Schaarschmidt
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Mannheim Universität Heidelberg Mannheim Deutschland
| | - Wolfgang Harth
- Klinik für Dermatologie und Allergologie Vivantes Klinikum Spandau Berlin Deutschland
| | - Rotraut Mössner
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen Göttingen Deutschland
| | - Christian Kromer
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen Göttingen Deutschland
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6
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Lang Y, Wu B, Sun Z, Ye E, Dou G, Guan X. Patient Preference for Biologic Treatments of Psoriasis in the Chinese Setting. Patient Prefer Adherence 2022; 16:1071-1084. [PMID: 35479654 PMCID: PMC9038155 DOI: 10.2147/ppa.s357795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Assessments of patients' preferences can support in clinical decision-making regarding biologic therapies for psoriasis. Our objective was to investigate patient preference for biologic treatments in patients with psoriasis in China. METHODS From October 2020 to January 2021, psoriasis patients were recruited for a survey that included demographic and disease-related questions, as well as a discrete choice experiment to measure their preferences for biologic therapy. A discrete-choice experiment was used in which respondents selected psoriasis treatments based on benefits (ie, early onset of efficacy, long-term efficacy, sustained efficacy) and treatment costs. We analyzed choice data using conditional logit model. RESULTS This study included 236 patients with moderate-to-severe psoriasis. The relative importance of the cost of biologic treatments, probability of keeping PASI100 at 5 years, probability of achieving PASI100 at 3 months and time to achieve PASI50 after initiation the biologic treatment were 0.593, 0.137, 0.185 and 0.085. Over 50% of patients regarded the cost of biologic treatments as the most important attribute. High-income and low-income subgroups had higher preference weight in probability of achieving PASI100 at 3-month and monthly cost. CONCLUSION The cost of biologic treatments was found as the most important attribute for Chinese patients with psoriasis. Among efficacy attributes, the probability of achieving PASI100 at 3 months showed most sensitive. These results may be helpful to understand patient preference for biologic treatments used for psoriasis in China.
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Affiliation(s)
- Yitian Lang
- Department of Pharmacy, Huangpu Branch, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People’s Republic of China
| | - Bin Wu
- Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 201100, People’s Republic of China
| | - Zhilin Sun
- Department of Dermatology, Peking University Third Hospital, Peking University, Haidian District, Beijing, People’s Republic of China
| | - Erjia Ye
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, People’s Republic of China
| | - Guanshen Dou
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, People’s Republic of China
| | - Xin Guan
- Department of Dermatology, Peking University Third Hospital, Peking University, Haidian District, Beijing, People’s Republic of China
- Correspondence: Xin Guan, Department of Dermatology, Peking University Third Hospital, Peking University, No. 49, Huayuan North Road, Haidian District, Beijing, People’s Republic of China, Email
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7
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Gonzalez JM, Reed SD, Johnson FR. Stratified psoriasis treatment plans: why is patient preference information needed? Br J Dermatol 2021; 185:882-883. [PMID: 34463961 DOI: 10.1111/bjd.20697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- J M Gonzalez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - S D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - F R Johnson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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8
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Boeri M, Saure D, Schuster C, Hill J, Guerreiro M, Klein K, Hauber B. Impact of clinical and demographic characteristics on patient preferences for psoriasis treatment features: Results from a discrete-choice experiment in a multicountry study. J DERMATOL TREAT 2021; 33:1598-1605. [PMID: 33406942 DOI: 10.1080/09546634.2020.1869145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aimed to elicit preferences for psoriasis treatment features and to test for preference heterogeneity across groups of respondents. MATERIALS AND METHODS A discrete-choice experiment was employed to elicit preferences of patients with plaque psoriasis in multiple countries. The survey instrument included a series of choice questions between three hypothetical treatments, each characterized by varying levels of six attributes (namely, lesion reduction, risk of impairing side effects, time to reach results, mode and frequency of administration, itching reduction, and side effects). Random parameters logit was used to model the data. Results were compared across a total of 18 subgroup sets. RESULTS The data analysis from 1,123 respondents showed that, on average, respondents receive more utility gain from higher levels of lesion reduction and lower risks of impairing side effects than changes in other attributes included in the study. Systematic differences were detected for 13 sets; the most pronounced differences were observed based on disease severity, nail psoriasis, biologic experience, and quality-of-life scores. CONCLUSION These many sources of preference heterogeneity identified by our analysis suggest that to improve patient satisfaction and, probably, adherence and persistence, clinicians should discuss options with patients when prescribing their treatment.
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Affiliation(s)
- Marco Boeri
- RTI Health Solutions, Health Preference Assessment, Belfast, UK
| | | | - Christopher Schuster
- Eli Lilly and Company, Vienna, Austria.,Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | | | - Kathleen Klein
- RTI Health Solutions, Health Preference Assessment, Research Triangle Park, NC, USA
| | - Brett Hauber
- RTI Health Solutions, Health Preference Assessment, Research Triangle Park, NC, USA
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9
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Lukmanji A, Basmadjian RB, Vallerand IA, Patten SB, Tang KL. Risk of Depression in Patients With Psoriatic Disease: A Systematic Review and Meta-Analysis. J Cutan Med Surg 2020; 25:257-270. [PMID: 33263264 DOI: 10.1177/1203475420977477] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous systematic reviews have assessed the prevalence and odds ratio (OR) of depression for patients with psoriatic disease. Due to probable bidirectional effects, prevalence and prevalence ORs are difficult to interpret. No prior reviews have quantified the relative risk (RR) of depression following a diagnosis of psoriatic disease. OBJECTIVE To estimate the RR of depression in individuals with psoriasis and in psoriatic arthritis (PsA), clear-to-moderate psoriasis, and moderate-to-severe psoriasis subgroups. METHODS Observational studies investigating the risk of depression in adults with psoriatic disease were systematically searched for in Medline, EMBASE, PsycINFO, and CINAHL databases; 4989 unique references were screened. Studies that reported measures of incident depression in psoriasis patients were included. Thirty-one studies were included into the systematic review, of which 17 were meta-analyzed. Random effects models were employed to synthesize relevant data. Sources of heterogeneity were explored with subgroup analysis and meta-regression. RESULTS Seventeen studies were included in meta-analyses. The pooled RR of depression in psoriasis patients compared to nonpsoriasis controls was 1.48 (95% CI: 1.16-1.89). Heterogeneity was high (I2 = 99.8%). Subgroup analysis and meta-regression did not indicate that PsA status or psoriasis severity (clear-to-mild, moderate-to-severe) were sources of heterogeneity. No evidence of publication bias was found. CONCLUSIONS This review demonstrates that the risk of depression is greater in patients with psoriasis and PsA. Future research should focus on developing strategies to address the mental health needs of this patient population for depression, including primary prevention, earlier detection, and treatment strategies.
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Affiliation(s)
- Aysha Lukmanji
- 2129 Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Robert B Basmadjian
- 2129 Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Isabelle A Vallerand
- 2129 Department of Medicine, University of Calgary, AB, Canada.,70401 Division of Dermatology, University of Calgary, AB, Canada
| | - Scott B Patten
- 2129 Department of Community Health Sciences, University of Calgary, AB, Canada.,2129 Department of Medicine, University of Calgary, AB, Canada.,2129 Mathison Centre for Mental Health Research & Education, University of Calgary, AB, Canada.,2129 Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, AB, Canada
| | - Karen L Tang
- 2129 Department of Community Health Sciences, University of Calgary, AB, Canada.,2129 Department of Medicine, University of Calgary, AB, Canada
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10
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Bell KA, Balogh EA, Feldman SR. An update on the impact of depression on the treatment of psoriasis. Expert Opin Pharmacother 2020; 22:695-703. [PMID: 33198529 DOI: 10.1080/14656566.2020.1849141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: Estimates of the prevalence of comorbid depression vary, ranging from 9 and 62%. Deterioration of mental health may emerge as a result of psoriasis; however, it is theorized that depression alone may independently predispose patients to new-onset psoriasis.Areas covered: The aim of this brief review is to explore the impact of depression on psoriasis treatment.Expert opinion: The two studies that directly assess the role of depression in psoriasis treatment outcomes are important, as unaddressed depression can undermine the success of a given treatment. This may reflect the notion that depressed individuals are less likely to be adherent. Thus, it may be valuable for clinicians to not only screen for depression, but to ensure that it is adequately treated. Our knowledge of treatment preferences in psoriasis patients with comorbid depression is limited. Expanding our understanding of preferences may allow providers to better align their recommendations to ultimately increase adherence. Additionally, given that many psoriasis treatments have an impact on depression, it may be beneficial for clinicians to evaluate patients for psychiatric risk factors to optimize the treatment regimen.
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Affiliation(s)
- Katheryn A Bell
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Esther A Balogh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
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11
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Sain N, Willems D, Charokopou M, Hiligsmann M. The importance of understanding patient and physician preferences for psoriasis treatment characteristics: a systematic review of discrete-choice experiments. Curr Med Res Opin 2020; 36:1257-1275. [PMID: 32468865 DOI: 10.1080/03007995.2020.1776233] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Treatment adherence continues to be a major challenge in psoriasis. Patient preference studies, especially discrete-choice experiments, are gaining popularity to gather insights into patient reported treatment outcomes. This systematic literature review aimed to critically assess all discrete choice experiments exploring patients' and physicians' preferences for psoriasis treatment characteristics.Methods: PubMed and EMBASE databases were searched using keywords "psoriasis" and "preferences" to identify relevant literature. Discrete-choice experiments conducted in French or English from the year 2000 onwards, that focused on evaluating psoriasis treatment preferences in patients and/or physicians, were included. The relative importance of treatment attributes was assessed and studies were critically appraised using validated checklists.Results: Out of 987 articles identified, 25 articles fulfilled the inclusion criteria. Overall, patients and physicians prioritize efficacy-specific outcomes. Patients are shown to place greater importance to process attributes when compared to physicians, especially route and location of administration. Physicians focus primarily of efficacy attributes, however when the top two attributes are considered, safety outcomes increasingly become considered important. Of the studies, 60% conducted subgroup analysis, of which many reported associations between specific patient characteristics and preferences. Factors such as age, disease severity, and duration of condition significantly affected preferences for treatment attributes.Conclusions: This review provides insight into the types of attributes that patients and physicians value most, and therefore can help improve shared decision-making. The findings of this study also encourage regulatory agencies to continue integrating patient preferences in their decision-making.
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Affiliation(s)
- Noem Sain
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Damon Willems
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- UCB Pharma, Brussels, Belgium
| | | | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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12
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Boeri M, Saure D, Schacht A, Riedl E, Hauber B. Modeling Heterogeneity in Patients' Preferences for Psoriasis Treatments in a Multicountry Study: A Comparison Between Random-Parameters Logit and Latent Class Approaches. PHARMACOECONOMICS 2020; 38:593-606. [PMID: 32128726 DOI: 10.1007/s40273-020-00894-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Either a random-parameters logit (RPL) or latent class (LC) model can be used to model or explain preference heterogeneity in discrete-choice experiment (DCE) data. The former assumes continuous distribution of preferences across the sample, while the latter assumes a discrete distribution. This study compared RPL and LC models to explore preference heterogeneity when analyzing patient preferences for psoriasis treatments. METHODS Using DCE data collected from respondents with moderate-to-severe plaque psoriasis, we calculated and compared preference weights derived from RPL and LC models. We then compared how RPL and LC explain preference heterogeneity by exploring differences across subgroups defined by observed characteristics (i.e., country, age, gender, marital status, and psoriasis severity). RESULTS While RPL and LC models resulted in the same mean preference weights, different preference-heterogeneity patterns emerged from the two approaches. In both models, country of residence and self-reported disease severity could be linked to systematic differences in preferences. The RPL also identified gender and marital status, but not age, as sources of heterogeneity; the LC membership probability model indicated that age was a significant factor, but not gender or marital status. CONCLUSIONS Using data from a psoriasis patient survey to compare two widely used methods for exploring heterogeneity identified differences in results between stated-preferences: subgroup analysis in the RPL model and inclusion of subgroup characteristics in the class membership probability function of the LC model. Researchers should model data using the most adaptable approach to address the initial study question.
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Affiliation(s)
- Marco Boeri
- RTI Health Solutions, Health Preference Assessment, Forsyth House, Cromac Square, Belfast, BT2 8LA, UK.
| | | | | | | | - Brett Hauber
- RTI Health Solutions, Health Preference Assessment, Research Triangle Park, NC, USA
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Florek AG, Wang CJ, Armstrong AW. Treatment preferences and treatment satisfaction among psoriasis patients: a systematic review. Arch Dermatol Res 2018; 310:271-319. [DOI: 10.1007/s00403-018-1808-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/21/2017] [Accepted: 01/12/2018] [Indexed: 12/01/2022]
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14
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Rigopoulos D, Ioannides D, Chaidemenos G, Kallidis P, Voultsidou A, Matekovits A, Soura E. Patient preference study for different characteristics of systemic psoriasis treatments (Protimisis). Dermatol Ther 2018; 31:e12592. [DOI: 10.1111/dth.12592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/19/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Affiliation(s)
- D. Rigopoulos
- 1st Department of Dermatology‐VenereologyMedical School, National and Kapodistrian University of Athens, Andreas Sygros HospitalAthens Greece
| | - D. Ioannides
- 1st Department of DermatologyAristotle UniversityThessaloniki Greece
| | | | | | | | | | - E. Soura
- 1st Department of Dermatology‐VenereologyMedical School, National and Kapodistrian University of Athens, Andreas Sygros HospitalAthens Greece
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Gonzalez JM. Evaluating Risk Tolerance from a Systematic Review of Preferences: The Case of Patients with Psoriasis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:285-300. [DOI: 10.1007/s40271-017-0295-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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16
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Pompili M, Innamorati M, Forte A, Erbuto D, Lamis DA, Narcisi A, Rea C, Orsini D, D'Arino A, Arcese A, Bellini S, Trovarelli S, Serafini G, Amore M, Costanzo A, Girardi P. Psychiatric comorbidity and suicidal ideation in psoriasis, melanoma and allergic disorders. Int J Psychiatry Clin Pract 2017; 21:209-214. [PMID: 28326880 DOI: 10.1080/13651501.2017.1301482] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Psychiatric disorders and suicide risk (especially in psoriasis) are frequent and disabling conditions in patients with skin diseases. The aim of this study was to examine the risk of suicide and stressful life events in a sample of patients with skin disease. METHODS A sample of 242 dermatological patients (142 women and 100 men), 112 of which had psoriasis, 77 had melanoma, and 53 were suffering with chronic allergic diseases. Patients were administered the MINI International Neuropsychiatric Interview (MINI), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). Patients were also asked about their experiences with stressful life events. RESULTS Patients with psoriasis were more likely to have a history of psychiatric disorders (36.6% vs. 13.2% χ2(1) = 9.55; p = 0.002) compared to patients with allergies. Specifically, patients with psoriasis more likely had a diagnosis of a mood disorder (16.1% vs. 3.9% χ2(1) = 6.85; p = 0.009; 16.1% vs. 0% χ2(1) = 9.56; p = 0.002) and reported past suicidal ideation (33.9% vs. 15.6% χ2(1) = 7.89; p = 0.005; 33.9% vs. 18.9% χ2(1) = 3.96; p = 0.047) as compared to those with melanoma and allergy. CONCLUSIONS The results from this study suggest that patients affected by psoriasis have an increased risk of psychiatric comorbidities and suicidal ideation compared to those who have other dermatological disorders.
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Affiliation(s)
- Maurizio Pompili
- a Department of Neurosciences, Mental Health and Sensory Organs , Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Marco Innamorati
- b Department of Human Sciences , European University of Rome , Rome , Italy
| | - Alberto Forte
- a Department of Neurosciences, Mental Health and Sensory Organs , Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Denise Erbuto
- a Department of Neurosciences, Mental Health and Sensory Organs , Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Dorian A Lamis
- c Department of Psychiatry and Behavioral Sciences , Emory University School of Medicine , Atlanta , GA , USA
| | - Alessandra Narcisi
- d Dermatology Unit, Department of Neurosciences, Mental Health and Sensory Organs , Sapienza University of Rome , Rome , Italy
| | - Claudia Rea
- a Department of Neurosciences, Mental Health and Sensory Organs , Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Diego Orsini
- d Dermatology Unit, Department of Neurosciences, Mental Health and Sensory Organs , Sapienza University of Rome , Rome , Italy
| | - Andrea D'Arino
- d Dermatology Unit, Department of Neurosciences, Mental Health and Sensory Organs , Sapienza University of Rome , Rome , Italy
| | - Annalisa Arcese
- d Dermatology Unit, Department of Neurosciences, Mental Health and Sensory Organs , Sapienza University of Rome , Rome , Italy
| | - Samantha Bellini
- a Department of Neurosciences, Mental Health and Sensory Organs , Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Sara Trovarelli
- a Department of Neurosciences, Mental Health and Sensory Organs , Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Gianluca Serafini
- e Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry , University of Genova , Genova, Italy
| | - Mario Amore
- e Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry , University of Genova , Genova, Italy
| | - Antonio Costanzo
- f Dermatology Unit, Department of Biomedical Sciences , Humanitas University , Rozzano-Milan , Italy
| | - Paolo Girardi
- a Department of Neurosciences, Mental Health and Sensory Organs , Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
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Pompili M, Innamorati M, Trovarelli S, Narcisi A, Bellini S, Orsini D, Forte A, Erbuto D, Botti E, Lamis DA, Girardi P, Costanzo A. Suicide risk and psychiatric comorbidity in patients with psoriasis. J Int Med Res 2016; 44:61-66. [PMID: 27683142 PMCID: PMC5536523 DOI: 10.1177/0300060515593253] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives To examine the occurrence of stressful life events, psychological comorbidity and suicide risk in patients with psoriasis or other dermatological conditions. Methods Consecutive adult outpatients with psoriasis or other dermatological conditions completed a sociodemographic questionnaire and the Hamilton scales for depression and anxiety. Results The study included 157 patients (91 with psoriasis; 66 with other conditions [melanoma; allergy]). Patients with psoriasis were significantly more likely to have experienced major life events in the 12 months before diagnosis, have had a psychiatric diagnosis and to have experienced past suicidal ideation than patients with other dermatological conditions. Conclusions Patients with psoriasis have an increased risk of psychiatric comorbidities, suicidal ideation, and long-term course of the disease compared with patients who have other dermatological conditions. Psychiatric assessment is highly recommended in patients with psoriasis.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, S.Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Sara Trovarelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, S.Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Alessandra Narcisi
- Dermatology Unit, Department of Neurosciences, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
| | - Samantha Bellini
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, S.Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Diego Orsini
- Dermatology Unit, Department of Neurosciences, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
| | - Alberto Forte
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, S.Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Denise Erbuto
- Dermatology Unit, Department of Neurosciences, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
| | - Elisabetta Botti
- Dermatology Unit, Department of Neurosciences, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, S.Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Antonio Costanzo
- Dermatology Unit, Department of Neurosciences, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
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18
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Gonzalez JM, Johnson FR, McAteer H, Posner J, Mughal F. Comparing preferences for outcomes of psoriasis treatments among patients and dermatologists in the U.K.: results from a discrete-choice experiment. Br J Dermatol 2016; 176:777-785. [PMID: 27292093 DOI: 10.1111/bjd.14798] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Plaque psoriasis can have a significant negative effect on patients' quality of life, and treatments can result in serious toxicities. Although there have been several studies of patients' and physicians' relative preferences for the benefits and risks of psoriasis treatments, it is unclear how and whether patients' and physicians' preferences for the outcomes of psoriasis treatments differ. OBJECTIVES To quantify patient and dermatologist preferences for improvements in psoriasis symptoms and for increases in the risk of treatment-related serious adverse events. METHODS Members of the U.K. Psoriasis Association and U.K. dermatologists with experience prescribing biologics completed a web-enabled discrete-choice experiment survey in which they evaluated efficacy and safety features of biological treatments for psoriasis. Choices between hypothetical treatment options were used to estimate preference weights indicating respondents' relative trade-off preferences among treatment outcomes. These outcomes included improvements in the severity and coverage of psoriatic plaques and treatment-related risks of tuberculosis, serious infections and lymphoma. Preference estimates were used to derive the maximum level of side-effect risks that respondents would accept for improvements in psoriasis symptoms. RESULTS Respondents' tolerance for side-effect risks varied with side-effect severity and location of plaques, and risk tolerance for serious side-effects was greater for patients than for dermatologists. CONCLUSIONS Estimates of patients' risk tolerance for serious side-effects indicate that patients valued psoriasis symptom control highly and suggest that psoriasis symptoms have a significant effect on patients' quality of life. In light of research showing increased treatment satisfaction and improved treatment adherence among patients who receive therapies that are consistent with their preferences, our findings suggest that greater communication between dermatologists and patients about risk tolerance could help improve patient care.
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Affiliation(s)
- J M Gonzalez
- RTI Health Solutions, Research Triangle Park, NC, U.S.A
| | - F R Johnson
- Duke Clinical Research Institute, Duke University, Durham, NC, U.S.A
| | - H McAteer
- Psoriasis Association, Northampton, U.K
| | - J Posner
- RTI Health Solutions, Research Triangle Park, NC, U.S.A
| | - F Mughal
- RTI Health Solutions, Research Triangle Park, NC, U.S.A
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19
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20
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Gutknecht M, Schaarschmidt ML, Herrlein O, Augustin M. A systematic review on methods used to evaluate patient preferences in psoriasis treatments. J Eur Acad Dermatol Venereol 2016; 30:1454-64. [DOI: 10.1111/jdv.13749] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- M. Gutknecht
- Institute for Health Services Research in Dermatology and Nursing (IVDP); German Center for Health Services Research in Dermatology (CVderm); University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - M.-L. Schaarschmidt
- Institute for Health Services Research in Dermatology and Nursing (IVDP); German Center for Health Services Research in Dermatology (CVderm); University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - O. Herrlein
- Institute for Health Services Research in Dermatology and Nursing (IVDP); German Center for Health Services Research in Dermatology (CVderm); University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP); German Center for Health Services Research in Dermatology (CVderm); University Medical Center Hamburg-Eppendorf; Hamburg Germany
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Laba TL, Essue B, Kimman M, Jan S. Understanding Patient Preferences in Medication Nonadherence: A Review of Stated Preference Data. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:385-95. [PMID: 25404203 DOI: 10.1007/s40271-014-0099-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nonadherence is a global problem undermining the cost-effectiveness of evidence-based medications. Aligning treatment choices with patient preferences may promote adherent behaviour: eliciting patient treatment preferences may help resolve the problem of nonadherence. As there is no reliable measure of nonadherent behaviour that can be used to derive preferences, stated-preference techniques offer a robust alternative. To understand patient preferences in medication nonadherence, we systematically appraised full-text English studies (from database inception to 24 February 2014) involving participants evaluating hypothetical scenarios to elicit preferences as an explicit means to understand medication nonadherence. Study characteristics (e.g. setting, disease, stated-preference method), attribute type and influence on choice were extracted. Seventeen full-text articles (4,456 patients) were included in the review, which reports stated-preference elicitation studies across a wide range of chronic and acute conditions. All studies were conducted in high-income settings. The influence of drug-related factors was predominant in patients' preferences for treatment. Patients preferred efficacious over safe medications except when considering the duration of therapy, but dosing and cost appeared more important when contemplating adherence. Patient characteristics, particularly medication experience, significantly influenced preferences. A disparity between stated preferences for treatment and adherence was reported. When using stated-preference techniques to understand nonadherence, this manuscript highlights that there is much room for methodological development. Studies outside of high-income settings are needed, particularly in relation to chronic diseases, for which nonadherence poses a substantial economic burden to health systems and patients. To inform the problem of sustaining adherence, prospective research is needed to understand how preferences change with time. The usefulness of stated-preference techniques to inform policy and practice requires a better understanding of how stated preferences relate to actual adherence behaviour.
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Affiliation(s)
- Tracey-Lea Laba
- The George Institute for Global Health, University of Sydney, Camperdown, NSW, 2010, Australia. .,The Faculty of Pharmacy, University of Sydney, Camperdown, NSW, 2010, Australia.
| | - Beverley Essue
- The George Institute for Global Health, University of Sydney, Camperdown, NSW, 2010, Australia.,The Menzies Centre for Health Policy, University of Sydney, Camperdown, NSW, 2010, Australia
| | - Merel Kimman
- The George Institute for Global Health, University of Sydney, Camperdown, NSW, 2010, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of Sydney, Camperdown, NSW, 2010, Australia.,The Menzies Centre for Health Policy, University of Sydney, Camperdown, NSW, 2010, Australia
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22
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Kim J, Kim DJ, Ortenzio FS, Dare L, Frank C, Kost RG, Lowes MA. Patients With Psoriasis and Personalized Trade-offs in Treatment Decisions-Lessons Learned From Focus Groups. JAMA Dermatol 2016; 152:720-2. [PMID: 27028481 DOI: 10.1001/jamadermatol.2016.0501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jaehwan Kim
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Dong Joo Kim
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Francesca S Ortenzio
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Lynn Dare
- Christine Frank and Associates: Research and Evaluation, Barrie, Ontario, Canada
| | - Christine Frank
- Christine Frank and Associates: Research and Evaluation, Barrie, Ontario, Canada
| | - Rhonda G Kost
- Center for Clinical and Translational Science, The Rockefeller University, New York, New York
| | - Michelle A Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
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Stewart KD, Johnston JA, Matza LS, Curtis SE, Havel HA, Sweetana SA, Gelhorn HL. Preference for pharmaceutical formulation and treatment process attributes. Patient Prefer Adherence 2016; 10:1385-99. [PMID: 27528802 PMCID: PMC4970633 DOI: 10.2147/ppa.s101821] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Pharmaceutical formulation and treatment process attributes, such as dose frequency and route of administration, can have an impact on quality of life, treatment adherence, and disease outcomes. The aim of this literature review was to examine studies on preferences for pharmaceutical treatment process attributes, focusing on research in diabetes, oncology, osteoporosis, and autoimmune disorders. METHODS The literature search focused on identifying studies reporting preferences for attributes of the pharmaceutical treatment process. Studies were required to use formal quantitative preference assessment methods, such as utility valuation, conjoint analysis, or contingent valuation. Searches were conducted using Medline, EMBASE, Cochrane Library, Health Economic Evaluation Database, and National Health Service Economic Evaluation Database (January 1993-October 2013). RESULTS A total of 42 studies met inclusion criteria: 19 diabetes, nine oncology, five osteoporosis, and nine autoimmune. Across these conditions, treatments associated with shorter treatment duration, less frequent administration, greater flexibility, and less invasive routes of administration were preferred over more burdensome or complex treatments. While efficacy and safety often had greater relative importance than treatment process, treatment process also had a quantifiable impact on preference. In some instances, particularly in diabetes and autoimmune disorders, treatment process attributes had greater relative importance than some or all efficacy and safety attributes. Some studies suggested that relative importance of treatment process depends on disease (eg, acute vs chronic) and patient (eg, injection experience) characteristics. CONCLUSION Despite heterogeneity in study methods and design, some general patterns of preference clearly emerged. Overall, the results of this review suggest that treatment process has a quantifiable impact on preference and willingness to pay for treatment, even in many situations where safety and efficacy were the primary concerns. Patient preferences for treatment process attributes can inform drug development decisions to better meet the needs of patients and deliver improved outcomes.
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Affiliation(s)
- Katie D Stewart
- Outcomes Research, Evidera, Bethesda, MD, USA
- Correspondence: Katie D Stewart, Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814, USA, Tel +1 240 235 2493, Fax +1 301 654 9864, Email
| | | | | | | | - Henry A Havel
- Small Molecule Design and Development, Eli Lilly & Company, Indianapolis, IN, USA
| | - Stephanie A Sweetana
- Small Molecule Design and Development, Eli Lilly & Company, Indianapolis, IN, USA
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Schaarschmidt ML, Kromer C, Herr R, Schmieder A, Sonntag D, Goerdt S, Peitsch WK. Patient Preferences for Biologicals in Psoriasis: Top Priority of Safety for Cardiovascular Patients. PLoS One 2015; 10:e0144335. [PMID: 26633680 PMCID: PMC4669171 DOI: 10.1371/journal.pone.0144335] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 11/17/2015] [Indexed: 02/08/2023] Open
Abstract
Patients with psoriasis are often affected by comorbidities, which largely influence treatment decisions. Here we performed conjoint analysis to assess the impact of comorbidities on preferences of patients with moderate-to-severe psoriasis for outcome (probability of 50% and 90% improvement, time until response, sustainability of success, probability of mild and severe adverse events (AE), probability of ACR 20 response) and process attributes (treatment location, frequency, duration and delivery method) of biologicals. The influence of comorbidities on Relative Importance Scores (RIS) was determined with analysis of variance and multivariate regression. Among the 200 participants completing the study, 22.5% suffered from psoriatic arthritis, 31.5% from arterial hypertension, 15% from cardiovascular disease (myocardial infarction, stroke, coronary artery disease, and/or arterial occlusive disease), 14.5% from diabetes, 11% from hyperlipidemia, 26% from chronic bronchitis or asthma and 12.5% from depression. Participants with psoriatic arthritis attached greater importance to ACR 20 response (RIS = 10.3 vs. 5.0, p<0.001; β = 0.278, p<0.001) and sustainability (RIS = 5.8 vs. 5.0, p = 0.032) but less value to time until response (RIS = 3.4 vs. 4.8, p = 0.045) than those without arthritis. Participants with arterial hypertension were particularly interested in a low risk of mild AE (RIS 9.7 vs. 12.1; p = 0.033) and a short treatment duration (RIS = 8.0 vs. 9.6, p = 0.002). Those with cardiovascular disease worried more about mild AE (RIS = 12.8 vs. 10, p = 0.027; β = 0.170, p = 0.027) and severe AE (RIS = 23.2 vs. 16.2, p = 0.001; β = 0.203, p = 0.007) but cared less about time until response (β = -0.189, p = 0.013), treatment location (β = -0.153, p = 0.049), frequency (β = -0.20, p = 0.008) and delivery method (β = -0.175, p = 0.023) than others. Patients’ concerns should be addressed in-depth when prescribing biologicals to comorbid patients, keeping in mind that TNF antagonists may favourably influence cardiovascular risk.
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Affiliation(s)
- Marthe-Lisa Schaarschmidt
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Kromer
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Raphael Herr
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Astrid Schmieder
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Diana Sonntag
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sergij Goerdt
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Wiebke K. Peitsch
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
- * E-mail:
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Eissing L, Radtke M, Zander N, Augustin M. Barriers to guideline-compliant psoriasis care: analyses and concepts. J Eur Acad Dermatol Venereol 2015; 30:569-75. [DOI: 10.1111/jdv.13452] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/04/2015] [Indexed: 12/18/2022]
Affiliation(s)
- L. Eissing
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - M.A. Radtke
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - N. Zander
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
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26
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de la Brassinne M, Ghislain PD, Lambert JLW, Lambert J, Segaert S, Willaert F. Recommendations for managing a suboptimal response to biologics for moderate-to-severe psoriasis: A Belgian perspective. J DERMATOL TREAT 2015; 27:128-33. [PMID: 26415615 DOI: 10.3109/09546634.2015.1086476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Over the past decade, biologics have become the gold standard in the treatment of moderate-to-severe psoriasis for patients who have failed or who have contraindications to traditional systemic treatments. However, although practical recommendations on how to treat a suboptimal response to biologics exist in other chronic inflammatory diseases, they are only just beginning to emerge for psoriasis. This article aims to formulate recommendations in the case of a suboptimal response of psoriasis to biologics in the Belgian setting. A Belgian taskforce of psoriasis experts was convened to review the results of a literature search and formulate recommendations based on the available evidence and provide expert opinion to address gaps in the evidence. The taskforce has proposed a treatment algorithm for patients with a primary non-response or a secondary loss of response to help address an unmet need. Expert recommendations have been developed to address treatment strategies in case of a primary or secondary suboptimal response to biologics in the treatment of moderate-to-severe psoriasis in Belgium.
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Affiliation(s)
- Michel de la Brassinne
- a Department of Dermatology , Centre Hospitalier Universitaire de Liège , Liège , Belgium
| | - Pierre-Dominique Ghislain
- b Department of Dermatology , Clinical Research, Cliniques Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Jo L W Lambert
- c Department of Dermatology , University of Ghent , Ghent , Belgium
| | - Julien Lambert
- d Department of Dermatology , University Hospital of Antwerp, University of Antwerp , Antwerp , Belgium
| | - Siegfried Segaert
- e Department of Dermatology , University Hospitals Leuven , Leuven , Belgium , and
| | - Fabienne Willaert
- f Department of Dermatology , Erasme University Hospital , Brussels , Belgium
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Schultze JL, Schmieder A, Goerdt S. Macrophage activation in human diseases. Semin Immunol 2015; 27:249-56. [PMID: 26303100 DOI: 10.1016/j.smim.2015.07.003] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 12/24/2022]
Abstract
It is becoming increasingly accepted that macrophages play a crucial role in many diseases associated with chronic inflammation, including atherosclerosis, obesity, diabetes, cancer, skin diseases, and even neurodegenerative diseases. It is therefore not surprising that macrophages in human diseases have gained significant interest during the last years. Molecular analysis combined with more sophisticated murine disease models and the application of genome-wide technologies has resulted in a much better understanding of the role of macrophages in human disease. We highlight important gain of knowledge during the last years for tumor-associated macrophages, and for macrophages in atherosclerosis, obesity and wound healing. Albeit these exciting findings certainly pave the way to novel diagnostics and therapeutics, several hurdles still need to be overcome. We propose a general outline for future research and development in disease-related macrophage biology based on integrating (1) genome-wide technologies, (2) direct human sampling, and (3) a dedicated use of in vivo model systems.
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Affiliation(s)
- Joachim L Schultze
- Genomics & Immunoregulation, LIMES-Institute, University of Bonn, Carl-Troll-Str. 31, D-53115 Bonn, Germany.
| | - Astrid Schmieder
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - S Goerdt
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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Patient Preferences for Treatment of Psoriasis with Biologicals: A Discrete Choice Experiment. PLoS One 2015; 10:e0129120. [PMID: 26058083 PMCID: PMC4461256 DOI: 10.1371/journal.pone.0129120] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 05/05/2015] [Indexed: 02/08/2023] Open
Abstract
Treatment dissatisfaction and non-adherence are common among patients with psoriasis, partly due to discordance between individual preferences and recommended treatments. However, patients are more satisfied with biologicals than with other treatments. The aim of our study was to assess patient preferences for treatment of psoriasis with biologicals by using computer-based conjoint analysis. Biologicals approved for psoriasis in Germany were decomposed into outcome (probability of 50% and 90% improvement, time until response, sustainability of success, probability of mild and severe adverse events (AE), probability of American College of Rheumatology (ACR) 20 response) and process attributes (treatment location, frequency, duration and delivery method). Impact of sociodemographic and socioeconomic characteristics and disease severity on Relative Importance Scores (RIS) of each attribute was assessed with analyses of variance, post hoc tests, and multivariate regression. Averaged across the cohort of 200 participants with moderate-to-severe psoriasis, preferences were highest for avoiding severe AE (RIS = 17.3), followed by 90% improvement (RIS = 14.0) and avoiding mild AE (RIS = 10.5). Process attributes reached intermediate RIS (8.2–8.8). Men were more concerned about efficacy than women (50% improvement: RIS = 6.9 vs. 9.5, p = 0.008; β = -0.191, p = 0.011 in multivariate models; 90% improvement: RIS = 12.1 vs. 15.4, p = 0.002; β = -0.197, p = 0.009). Older participants judged the probability of 50% and 90% improvement less relevant than younger ones (50% improvement: Pearson’s Correlation (PC) = -0.161, p = 0.022; β = -0.219, p = 0.017; 90% improvement: PC = -0.155, p = 0.028; β = -0.264, p = 0.004) but worried more about severe AE (PC = 0.175, p = 0.013; β = 0.166, p = 0.082). In summary, participants with moderate-to-severe psoriasis were most interested in safety of biologicals, followed by efficacy, but preferences varied with sociodemographic characteristics and working status. Based on this knowledge, physicians should identify preferences of each individual patient during shared decision-making in order to optimize treatment satisfaction, adherence and outcome.
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Harrison M, Rigby D, Vass C, Flynn T, Louviere J, Payne K. Risk as an Attribute in Discrete Choice Experiments: A Systematic Review of the Literature. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 7:151-70. [DOI: 10.1007/s40271-014-0048-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Torbica A, Fattore G, Ayala F. Eliciting preferences to inform patient-centred policies: the case of psoriasis. PHARMACOECONOMICS 2014; 32:209-223. [PMID: 24446282 DOI: 10.1007/s40273-013-0126-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess patient preferences for psoriasis treatment features and to investigate the heterogeneity of preferences among patients with different socio-demographic and disease-related characteristics. METHODOLOGY A discrete choice experiment was conducted on adult patients with moderate to severe plaque-type psoriasis during a routine visit to their physician at 15 centres in Italy. We investigated the preferences of patients with respect to five treatment attributes: (1) mode and frequency of administration; (2) time to improvement; (3) time free of symptoms; (4) unintended life expectancy reduction resulting from treatment; and (5) monthly treatment cost. The heterogeneity of preferences was investigated in a mixed logit model with normally distributed random coefficients. RESULTS Overall, patients preferred the subcutaneous or intravenous route of administration (versus oral administration) and treatments that took less time to show improvement, ensured a longer time free of symptoms, involved a lesser reduction in life expectancy and had lower costs. There was significant preference heterogeneity for all attributes. The cost attribute was found to be significantly more important to females and to older patients (above 60 years of age). Older patients placed significantly greater emphasis on reduced life expectancy, whereas the time free of symptoms was significantly less important to them than to patients under 60 years of age. Patients with higher scores on the Dermatology Life Quality Index (DLQI) placed higher value on the time free of symptoms than those with lower DLQI scores. For the overall sample, the marginal willingness to pay (WTP) for a month's reduction in the time to improvement was <euro>32.4, whereas the WTP for one additional month without symptoms was significantly higher (<euro>68.2). CONCLUSION Patient-centred policies should consider the heterogeneity of patients' expectations to identify individualized treatments that would aid in optimizing patient satisfaction and wellbeing, as well as overall treatment effectiveness.
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Affiliation(s)
- Aleksandra Torbica
- Department of Policy Analysis and Public Management, Università Commerciale Luigi Bocconi, Via Roentgen 1, 20136, Milan, Italy
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Husted JA, Thavaneswaran A, Chandran V, Gladman DD. Incremental Effects of Comorbidity on Quality of Life in Patients with Psoriatic Arthritis. J Rheumatol 2013; 40:1349-56. [DOI: 10.3899/jrheum.121500] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective.To assess the added effect of comorbidity on quality of life (QOL) in psoriatic arthritis (PsA).Methods.Between 2006 and 2012, 631 patients were recruited from the University of Toronto PsA Clinic. Using the clinical database, we ascertained the frequency of 15 comorbidities. The Medical Outcomes Study Short Form-36 (SF-36) physical (PCS) and mental component (MCS) summary scales were used to assess QOL. Linear regression analyses were conducted to estimate the magnitude of the association between number and type of comorbidities and PCS and MCS scores, after adjustment for disease-related and sociodemographic variables.Results.Prevalence of comorbidity was high, with 42% of patients having 3 or more comorbid conditions. After adjustment for inflammatory disease–related and sociodemographic factors, a history of 3 or more comorbid conditions accounted for only 2% and 1% of the R2 value explained in PCS and MCS scores, respectively. In terms of added burden, type of comorbid condition was more significant than number of comorbidities. After adjustment for disease-related and sociodemographic factors, fibromyalgia (FM), neurological disorders, and obesity jointly accounted for 6% of R2 value explained in PCS scores, while FM and depression/anxiety jointly accounted for about 9% of the R2 explained in MCS scores. The point decrease in PCS and MCS scores associated with each of these disorders was clinically significant. The 11 other comorbid conditions failed to achieve statistical significance in the models.Conclusion.The added effect of comorbidity on patient-reported physical and mental health in PsA was more related to type of comorbidity than number of comorbidities.
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Smolen JS, Braun J, Dougados M, Emery P, Fitzgerald O, Helliwell P, Kavanaugh A, Kvien TK, Landewé R, Luger T, Mease P, Olivieri I, Reveille J, Ritchlin C, Rudwaleit M, Schoels M, Sieper J, Wit MD, Baraliakos X, Betteridge N, Burgos-Vargas R, Collantes-Estevez E, Deodhar A, Elewaut D, Gossec L, Jongkees M, Maccarone M, Redlich K, van den Bosch F, Wei JCC, Winthrop K, van der Heijde D. Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force. Ann Rheum Dis 2013; 73:6-16. [PMID: 23749611 PMCID: PMC3888616 DOI: 10.1136/annrheumdis-2013-203419] [Citation(s) in RCA: 304] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Therapeutic targets have been defined for diseases like diabetes, hypertension or rheumatoid arthritis and adhering to them has improved outcomes. Such targets are just emerging for spondyloarthritis (SpA). OBJECTIVE To define the treatment target for SpA including ankylosing spondylitis and psoriatic arthritis (PsA) and develop recommendations for achieving the target, including a treat-to-target management strategy. METHODS Based on results of a systematic literature review and expert opinion, a task force of expert physicians and patients developed recommendations which were broadly discussed and voted upon in a Delphi-like process. Level of evidence, grade and strength of the recommendations were derived by respective means. The commonalities between axial SpA, peripheral SpA and PsA were discussed in detail. RESULTS Although the literature review did not reveal trials comparing a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated the development of recommendations. The group agreed on 5 overarching principles and 11 recommendations; 9 of these recommendations related commonly to the whole spectrum of SpA and PsA, and only 2 were designed separately for axial SpA, peripheral SpA and PsA. The main treatment target, which should be based on a shared decision with the patient, was defined as remission, with the alternative target of low disease activity. Follow-up examinations at regular intervals that depend on the patient's status should safeguard the evolution of disease activity towards the targeted goal. Additional recommendations relate to extra-articular and extramusculoskeletal aspects and other important factors, such as comorbidity. While the level of evidence was generally quite low, the mean strength of recommendation was 9-10 (10: maximum agreement) for all recommendations. A research agenda was formulated. CONCLUSIONS The task force defined the treatment target as remission or, alternatively, low disease activity, being aware that the evidence base is not strong and needs to be expanded by future research. These recommendations can inform the various stakeholders about expert opinion that aims for reaching optimal outcomes of SpA.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, , Vienna, Austria
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Umar N, Schöllgen I, Terris DD. It is not always about gains: utilities and disutilities associated with treatment features in patients with moderate-to-severe psoriasis. Patient Prefer Adherence 2012; 6:187-94. [PMID: 22536054 PMCID: PMC3333813 DOI: 10.2147/ppa.s29285] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Patient-centered care has been proposed as a strategy for improving treatment outcomes in the management of psoriasis and other chronic diseases. A more detailed understanding of patients' utilities and disutilities associated with treatment features may facilitate shared decision-making in the clinical encounter. The purpose of this study was to examine the features of psoriasis treatment that are most and least preferred by patients and to identify correlates of these preferences. METHODS A cross-sectional survey of 163 patients with moderate-to-severe psoriasis was conducted in a German academic medical center. We assessed patients' characteristics, elicited their preferences for a range of potential treatment features, and quantified preference scores (utilities) associated with each treatment feature using hierarchical Bayes estimation. After identifying the most and least preferred treatment features, we explored correlates of these preferences using multivariate regression models. RESULTS Mean preference scores (MPS) for the least preferred treatment features were consistently greater than those for the most preferred treatment features. Patients generally expressed strong preferences against prolonged treatments in the inpatient setting (MPS = -13.48) and those with a lower probability of benefit (MPS = -12.28), while treatments with a high probability of benefit (MPS = 10.51) were generally preferred. Younger patients and women were more concerned with treatment benefit as compared with older patients and men. CONCLUSION Both negative and positive preferences appear important for shared decision-making. Recognition of characteristics associated with strong negative preferences may be particularly useful in promoting patient-centered environments.
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Affiliation(s)
- Nasir Umar
- Mannheim Institute of Public Health, Social and Preventive Medicine, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Correspondence: Nasir Umar, Mannheim Institute of Public Health, Social and Preventive Medicine, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg, Ludolf-Krehl-Strasse 7–11, 68167 Mannheim, Germany, Tel +49 62 1383 9922, Fax +49 62 1383 9920, Email
| | - Ina Schöllgen
- Mannheim Institute of Public Health, Social and Preventive Medicine, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Darcey D Terris
- Mannheim Institute of Public Health, Social and Preventive Medicine, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
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