title: Moderate to severe psoriasis patients' subjective future expectations regarding health-related quality of life and longevity.
abstract: BACKGROUND
  Unrealistic expectations regarding treatments and clinical outcomes may lead to disappointment about therapy and sub-optimal compliance; nonetheless, these expectations have not been studied in psoriasis patients yet.
  
  
  OBJECTIVE
  To evaluate psoriasis patients' subjective future expectations regarding health-related quality of life (HRQOL) and life expectancy, and to explore clinical features associated with under- or overestimating behaviour.
  
  
  METHODS
  A cross-sectional questionnaire survey of consecutive adult patients with moderate to severe psoriasis was conducted. HRQOL expectations were recorded by applying the EQ-5D descriptive system for 6 months ahead and for future ages of 60, 70, 80 and 90 respectively.
  
  
  RESULTS
  In total, 167 patients (71% males) were included in the analysis with mean age of 50.4 ± 12.4 years and mean EQ-5D score of 0.71 ± 0.30. Overall 65% had chronic plaque psoriasis, 35% nail psoriasis, 35% scalp involvement, 29% psoriatic arthritis, 9% inverse psoriasis and 5% palmoplantar psoriasis respectively (combinations occurred). Participants expected 0.1 ± 0.23 mean improvement in EQ-5D within 6 months (P < 0.001) that achieves the minimum clinically important difference. Overall 37% expected improvement and 13% decline; however, 49% expected no changes in any of the five dimensions of EQ-5D within 6 months. Female gender, inverse or palmoplantar involvement and more severe psoriasis were likely associated with higher expectations. Patients at the initiation of their first biological at the time of the survey expected 0.18 ± 0.24 increase that seems to be realistic compared to the EQ-5D utility gain achieved in randomized controlled trials. Males expected by 2.7 ± 11.1 more, while females expected by 5.2 ± 9.3 less life years compared to the average statistical gender- and age-matched life expectancy (P < 0.05). Patients who expected to be alive at ages of 60, 70, 80 and 90 scored their future EQ-5D at ages of 60 to 90: 0.59 ± 0.46, 0.48 ± 0.41, 0.42 ± 0.41 and 0.22 ± 0.47 respectively.
  
  
  CONCLUSIONS
  Our findings highlight the importance of exploring expectations that might help to increase patients' compliance.
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.|Semmelweis University Doctoral School of Clinical Medicine, Budapest, Hungary.
authors.forename: F
authors.initials: F
authors.lastname: Rencz
authors.affiliation: Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary.
authors.forename: P
authors.initials: P
authors.lastname: Holló
authors.affiliation: Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary.
authors.forename: S
authors.initials: S
authors.lastname: Kárpáti
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.
authors.forename: M
authors.initials: M
authors.lastname: Péntek
authors.affiliation: Departments of Dermatology and Dermatological Allergology, University of Debrecen, Debrecen, Hungary.
authors.forename: É
authors.initials: É
authors.lastname: Remenyik
authors.affiliation: Departments of Dermatology and Dermatological Allergology, University of Debrecen, Debrecen, Hungary.
authors.forename: A
authors.initials: A
authors.lastname: Szegedi
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.
authors.forename: O
authors.initials: O
authors.lastname: Balogh
authors.affiliation: Departments of Dermatology and Dermatological Allergology, University of Debrecen, Debrecen, Hungary.
authors.forename: E
authors.initials: E
authors.lastname: Herédi
authors.affiliation: Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary.
authors.forename: K
authors.initials: K
authors.lastname: Herszényi
authors.affiliation: Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary.
authors.forename: H
authors.initials: H
authors.lastname: Jókai
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.
authors.forename: V
authors.initials: V
authors.lastname: Brodszky
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.
authors.forename: L
authors.initials: L
authors.lastname: Gulácsi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008136:Longevity; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000175:diagnosis* / Q000523:psychology; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires