Rethinking costs of psoriasis: 10% of patients account for nearly 40% of healthcare expenditures among enrollees with psoriasis in a U.S. health plan.
OBJECTIVE
To examine characteristics, healthcare utilization and costs among patients with psoriasis who have high medical costs.


METHODS
This is a retrospective study of patients with psoriasis with continuous enrollment from 1 January 2011 to 31 December 2013 in a large US health plan. Total paid 2012 healthcare costs excluding biologics (to identify costliest not due to biologic costs) were used to create cohorts representing the top 10% (T10) and bottom 90% (B90) of expenditures. Demographics, comorbidities, prescriptions, all-cause and psoriasis-related healthcare utilization and costs were compared between cohorts. Logistic regression identified demographic and clinical characteristics associated with the 2012 T10 cohort status.


RESULTS
18,653 patients (mean age 48 years; 49% female) were included. Patients in the T10 group accounted for 26% (2011), 39% (2012) and 26% (2013) of all-cause costs including biologics and 13% (2011), 18% (2012) and 11% (2013) of psoriasis-related costs. Mean 2012 total costs were $58,030 for T10 vs. $10,295 for B90 (all-cause) and $10,475 vs. $5301 (psoriasis-related). T10 patients in 2012 filled more prescriptions and were more likely to use corticosteroids (57% vs. 31%); however, biologic use and costs were similar (any use: 23% vs. 24%; prescriptions: 1.5 vs. 1.7, biologic costs: $4959 vs. $5095). Compared with B90 patients, T10 patients were more likely to have hospitalizations (all-cause: 45% vs. 3%; psoriasis-related: 14% vs. 1%) and ER visits (all-cause: 53% vs. 21%; psoriasis-related: 3% vs. 1%), and more likely to have renal disease (odds ratio (OR) = 2.05), depression (OR =1.96), cardiovascular disease (OR =1.88), psoriatic arthritis (OR =1.57) and diabetes (OR =1.50) (all p < .05).


CONCLUSIONS
The T10 patient cohort in 2012 accounted for nearly 40% of overall healthcare expenditures. However, cost differences between the T10 and B90 patients were not attributable to psoriasis-related biologic treatment utilization and costs. The T10 patients had significantly more inpatient and emergency utilization, and comorbid medical conditions.
a University of Southern California , Los Angeles , CA , USA.
April W
AW
Armstrong
b Health Economics and Outcomes Research , Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
Yang
Y
Zhao
b Health Economics and Outcomes Research , Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
Vivian
V
Herrera
b Health Economics and Outcomes Research , Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
Yunfeng
Y
Li
c Health Economics and Outcomes Research , Optum , Eden Prairie , MN , USA.
Tim
T
Bancroft
c Health Economics and Outcomes Research , Optum , Eden Prairie , MN , USA.
Michael
M
Hull
d Optum Labs , Eden Prairie , MN , USA.
Aylin
A
Altan
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D011565:Psoriasis / Q000188:drug therapy / Q000191:economics*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
D000305:Adrenal Cortex Hormones
Psoriasis; biologic medications; healthcare costs; healthcare utilization