title: Reducing patient copayment levels for topical and systemic treatments in plaque psoriasis as a case for evidence-based, sustainable pharmaceutical policy change in Greece.
abstract: OBJECTIVE
  Psoriasis is a chronic inflammatory skin disease that requires treatment to manage co-morbidities and improve patient quality-of-life. This study estimated the budget impact to National Organization for Health Care Services Provision (EOPYY) of changing reimbursement of psoriasis treatment with topical and systemic, non-biologic, agents (75%) to bring it on par with that of biologic agents (100%) in Greece.
  
  
  METHODS
  The Business Intelligence database of EOPYY was used to identify and provide analytics on patients with plaque psoriasis. Permission for use of anonymized data was obtained by the administration of EOPYY. EOPYY is responsible for funding healthcare and pharmaceutical care services for ∼95% of the permanent population in the country. Pre-defined ICD-10 codes were applied to identify patients with plaque psoriasis and at least one reimbursed prescription between 1 June 2014 and 31 May 2015. Age, gender, medications, and cost were recorded for these patients.
  
  
  RESULTS
  Of the 45,581 unique patients identified through completely anonymized data on the e-prescription system, 72% were on treatment with topicals only and accounted for 5% of EOPYY psoriasis expenditure. Another 9% of patients were on methotrexate or a per os (POS, orally administered) systemic agent and accounted for 2.35% of total expenditure. Approximately 12% of total patients were on treatment with a biologic-containing regimen and accounted for almost 90% of psoriasis expenditure. Patients on biologics were younger than patients on topical and systemic treatments. The burden to EOPYY of adjusting reimbursement levels for topical and systemic, non-biologic, treatments to 100% of their cost was estimated at €2.05 per patient per month for topical treatments (monotherapy) and an additional €9.5 per patient per month for treatment with methotrexate, POS systemic agents, and their combinations with topical agents. This additional cost is expected to be offset by averting 200 earlier than clinically necessary switches from topical and systemic, non-biologic, treatments to expensive biologics a year.
  
  
  CONCLUSIONS
  In circumstances of severe funding constraints for social health insurance in Greece, bringing patient copayment levels for psoriasis treatment on par with each other may aid proper clinical management of the condition, whilst achieving adequate treatment outcomes at optimal cost.
authors.affiliation: a University of Peloponnese , Faculty of Social and Political Sciences , Conrith , Greece.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Souliotis
authors.affiliation: b Policy Consultant , Maroussi , Athens , Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Golna
authors.affiliation: c National Organization for the Provision of Healthcare Services , Department of Planning and Monitoring of Medicines Dispensing, Medicines Division , Maroussi , Athens , Greece.
authors.forename: Chara
authors.initials: C
authors.lastname: Kani
authors.affiliation: c National Organization for the Provision of Healthcare Services , Department of Planning and Monitoring of Medicines Dispensing, Medicines Division , Maroussi , Athens , Greece.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Litsa
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D001688:Biological Products / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017047:Cost Sharing / Q000191:economics*; D003362:Cost-Benefit Analysis; D003879:Dermatologic Agents / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D006115:Greece; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011050:Policy Making; D011565:Psoriasis / Q000188:drug therapy*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D001688:Biological Products; D003879:Dermatologic Agents
keywords: Health policy; copayment; pharmaceutical policy; psoriasis; treatment cost