title: A psoriasis-specific model to support decision making in practice - UK experience.
abstract: OBJECTIVE
  The balance of service provision for people with psoriasis across community and hospital sectors is inappropriate in many localities. Disease-specific models are being used by policy makers to inform public health decision making and guide their long-term budgets. The aim of the present study was to develop an interactive psoriasis model to compare the 2-year outcomes of topical treatment strategies in patients with moderately severe psoriasis in real-world settings.
  
  
  METHODS
  A previously published 1-year economic analysis of the two-compound formulation (TCF) calcipotriol plus betamethasone dipropionate and other commonly used topical agents in plaque psoriasis was adapted. Literature review and an interview programme identified additional relevant data to inform model assumptions. The model estimated local psoriasis costs and resources in accord with decision makers' priorities. A key element of the model was the facility for all default input data to be adapted to reflect local circumstance. Model validation was not undertaken. The UK experience is described.
  
  
  RESULTS
  Topical treatment with high-efficacy first-line therapies is a cost-effective treatment strategy in moderate plaque psoriasis. The model predicts potential savings in psoriasis care for a UK population of £126 million over 2 years if all psoriasis patients received the TCF in a community setting. A frequently used feature of the model was to identify ways of reducing inappropriate referrals to hospital, and so enabling secondary care resources to be focussed on the most resilient psoriasis cases.
  
  
  CONCLUSIONS
  The present study psoriasis disease model could facilitate collaboration between healthcare professionals to optimise healthcare in the UK. Psoriasis management strategies in primary care can be compared in a variety of realistic clinical settings, allowing the identification of optimal treatment regimens. This model is adaptable to tailor inputs to reflect local situations, providing an attractive tool to GP commissioners. Country-specific adaptations are being researched in other European countries.
authors.affiliation: County Durham and Darlington NHS Foundation Trust & Sunderland Teaching Primary Care Trust, Sunderland, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Freeman
authors.forename: Maggie
authors.initials: M
authors.lastname: Marum
authors.forename: Julia M
authors.initials: JM
authors.lastname: Bottomley
authors.forename: Merran
authors.initials: M
authors.lastname: Auland
authors.forename: Peter
authors.initials: P
authors.lastname: Jackson
authors.forename: Jacob
authors.initials: J
authors.lastname: Ryttov
mesh_terms: D000287:Administration, Topical; D000465:Algorithms; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D003657:Decision Making / Q000502:physiology; D003661:Decision Support Techniques; D017048:Health Care Costs; D006801:Humans; D017059:Models, Econometric; D011364:Professional Practice; D011565:Psoriasis / Q000191:economics / Q000628:therapy*; D006113:United Kingdom
chemical_list: D000893:Anti-Inflammatory Agents