title: Economic and comorbidity burden among moderate-to-severe psoriasis patients with comorbid psoriatic arthritis.
abstract: OBJECTIVE
  To compare the prevalence of comorbidities, health care utilization, and costs between moderate-to-severe psoriasis (PsO) patients with comorbid psoriatic arthritis (PsA) and matched controls.
  
  
  METHODS
  Adults ages 18-64 years with concomitant diagnoses of PsO and PsA (PsO+PsA) were identified in the OptumHealth Reporting and Insights claims database between January 2007 and March 2012. Moderate-to-severe PsO was defined based on the use of at least one systemic or phototherapy during the 12-month study period after the index date (randomly selected date after the first PsO diagnosis). Control patients without PsO and PsA were demographically matched 1:1 with PsO+PsA patients. Multivariate regressions were employed to examine PsO/PsA-related comorbidities, medications, health care utilization, and costs between PsO+PsA patients and controls, adjusting for demographics, index year, insurance type, and non-PsO/PsA-related comorbidities.
  
  
  RESULTS
  Among 1,230 matched pairs of PsO+PsA patients and controls, PsO+PsA patients had significantly more PsO/PsA-related comorbidities, with the top 3 most common in both groups being hypertension (35.8% versus 23.5%), hyperlipidemia (34.6% versus 28.5%), and diabetes mellitus (15.9% versus 10.0%). Compared with controls, PsO+PsA patients had a higher number of distinct prescriptions filled (incidence rate ratio 2.3, P < 0.05); were more likely to have inpatient admissions (odds ratio [OR] 1.6), emergency room visits (OR 1.3), and outpatient visits (OR 62.7) (all P < 0.05); and incurred significantly higher total, pharmacy, and medical costs (adjusted annual cost differences per patient $23,160, $17,696, and $5,077, respectively; all P < 0.01).
  
  
  CONCLUSIONS
  Compared with matched PsO- and PsA-free controls, moderate-to-severe PsO patients with comorbid PsA had higher comorbidity and health care utilization and costs.
authors.affiliation: Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhao
authors.forename: Lizheng
authors.initials: L
authors.lastname: Shi
authors.forename: Mary Helen
authors.initials: MH
authors.lastname: Tran
authors.forename: Jackie
authors.initials: J
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D016208:Databases, Factual; D016527:Drug Costs; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D055815:Young Adult