title: Systemic treatment for moderate to severe psoriasis: estimates of failure rates and direct medical costs in a north-eastern US managed care plan.
abstract: BACKGROUND
  Estimates of US medical costs related to psoriasis treatment are limited and tend to understate the economic burden of moderate to severe psoriasis, which often requires the use of systemic agents, phototherapy or both.
  
  
  OBJECTIVE
  To estimate treatment failure rates and direct medical costs associated with the use of systemic agents and phototherapy in US patients with psoriasis.
  
  
  METHODS
  Claims records from a large New England-based health insurer were used to obtain patient-level data. Eligible patients with at least one claim listing an ICD-9-CM code for psoriasis (696.0; 696.1) were identified. Patients not receiving systemic treatments (methotrexate, cyclosporine, acitretin) or phototherapy (ultraviolet B with or without tar or petrolatum, psoralen and ultraviolet A [PUVA]) were excluded. Treatment failure was defined as a switch in therapy, augmentation with non-topical therapies, discontinuation following uptitration of dose or discontinuation following hospitalization. Medical costs included those related to pharmacy (over-the-counter medication excluded), institutional services (inpatient and outpatient) and professional services.
  
  
  RESULTS
  A total of 2068 patients with moderate to severe psoriasis were included in the analysis. Over a 1-year period, approximately 20% of patients experienced treatment failure. The mean time to failure among patients who switched therapy ranged from 3 to 6 months. Mean annual pharmacy costs in the various treatment groups (categorized according to initial therapy received) ranged from 257 dollars to 1992 dollars per patient. Mean annual costs for institutional and professional services ranged from 156 dollars to 799 dollars and 183 dollars to 481 dollars per patient, respectively. The 99th percentile annual pharmacy and institutional costs exceeded 10,000 dollars and 18,000 dollars, respectively.
  
  
  CONCLUSIONS
  Treatment of moderate to severe psoriasis with traditional systemic agents or phototherapy is associated with a high likelihood of treatment failure and a considerable economic burden.
authors.affiliation: Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. sfeldman@wfubmc.edu
authors.forename: S R
authors.initials: SR
authors.lastname: Feldman
authors.forename: C
authors.initials: C
authors.lastname: Evans
authors.forename: M W
authors.initials: MW
authors.lastname: Russell
mesh_terms: D017255:Acitretin / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D003365:Costs and Cost Analysis; D016572:Cyclosporine / Q000191:economics / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D008727:Methotrexate / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D009511:New England; D011701:PUVA Therapy / Q000191:economics; D010789:Phototherapy / Q000191:economics*; D011565:Psoriasis / Q000188:drug therapy* / Q000191:economics*; D017211:Treatment Failure; D014481:United States
chemical_list: D003879:Dermatologic Agents; D016572:Cyclosporine; D017255:Acitretin; D008727:Methotrexate