The Cost of Psoriasis Therapies: Considerations for Therapy Selection

Daniel J. Pearce; Crystal G. Thomas; Alan B. Fleischer, Jr.; Steven R. Feldman

Disclosures

Dermatology Nursing. 2004;16(5) 

In This Article

Abstract and Introduction

Purpose: The purpose of this article is to provide a review of the cost of psoriasis therapies from two sources as well as compare the average wholesale price (AWP), as listed in the 2003 Drug Topics Red Book to that of a popular Internet pharmacy.
Methods: Prices of therapies were obtained two ways: the AWP was recorded from the 2003 Drug Topics Red Book. A range and average price per gram (or mL) were calculated based on the smallest size or quantity available. In addition, a price comparison was made to values as they were reported online at drugstore.com. Monthly cost estimates were based on average systemic dosing and for topicals, 18 g/month (for 1% body surface area [BSA] involvement).
Results: The prices of psoriatic treatment medications vary considerably -- from the relatively inexpensive topical corticosteroids to the more costly biologic therapies. In the category of corticosteroids, a trend was evident between the overall price per gram of each class and the potency of each class. Class I and VI corticosteroids had an average price per gram (or mL) of $2.08 ($37/month/1% BSA) and $0.86 ($15/month/1% BSA), respectively. Nonsteroidal topical treatments had an average price per gram (or mL) $2.18 ($39/month/1% BSA). Systemic therapies have a wide range of costs. The total monthly expense, based on estimated average dosing, was calculated for methotrexate, acitretin, and cyclosporine and were $78.60, $400.50, and $735.00, respectively. Biologic therapies designed for continuous use cost roughly $1,300/month.
Discussion: There are numerous treatment options for psoriasis with a wide range of costs. In addition to significant challenges from a scientific perspective, psoriasis treatment is further complicated by the cost of the numerous medications. Prices reported in the AWP were similar in many instances to those listed at an Internet pharmacy. Many considerations should go into therapy selection for psoriasis and a comprehensive approach that includes cost will likely provide the best patient care.

Psoriasis can be a devastating disease and affects individuals not only physically and psychosocially, but financially as well. Given the cost and complexity of treatment regimens, the financial impact of psoriasis treatment can be significant for the patient and the health care delivery system. Caregivers should be equipped with information on treatment costs in order to provide the most appropriate patient care.

Psoriasis is a chronic relapsing inflammatory disorder of the skin that affects a significant number of the world's population. The effect of psoriasis on quality of life is well documented and is similar to other major medical diseases (Feldman et al., 1997; Ginsburg & Link, 1993; Gupta & Gupta, 2000; Rapp, Feldman, Exum, Fleischer, Jr., & Reboussin, 1999). There are physical, social, psychological, and financial implications that factor into quality of life of those living with this difficult disease (Devrimci-Ozguven, Kundakci, Kumbasar, & Boyvat, 2000; Feldman et al., 1997; Fried et al., 1995; Ginsburg & Link, 1993; Gupta & Gupta, 1998; Koo, 1996; Ramsay & O'Reagan, 1988).

The overall annual cost of caring for individuals with clinically significant psoriasis has been estimated to be from $650 million to $2 billion in the United States (Javitz, Ward, Farber, Nail, & Vallow, 2002). There are multiple variants of psoriasis as well as numerous treatment strategies that may require multi-drug regimens. This creates a complicated arena in which the physician must operate. During the past 10 years alone there has been an explosion in medications available for psoriasis. As the paradigm of psoriasis treatment shifts, so do the costs associated with novel medications. Knowledge of this cost information is vitally important to the clinician as the financial impact of therapy should be a consideration when treatment decisions are made.

Although many patients may have supplemental payment plans such as private insurance, or governmental subsidization, cost should remain a concern for the clinician. Cost-effective prescribing on behalf of the clinician will serve to minimize potential financial impact on the patient as well as limit the burden on the health care delivery system that may be involved. The realized cost to the patient is essentially determined by the medication itself and associated manufacturing/distribution costs, pharmacy charges, as well as any supplemental payment on behalf of a second party. The factor that clinicians may be able to control is the choice of medication.

The treatment of psoriasis is complex, owing to the diversity of clinical variants and severity, relapsing/remitting course, and the profound number of treatments available to the clinician. One factor often overlooked in selection of therapy is cost. Certain psoriasis medications can be associated with significant cost on behalf of the patient. There are many factors that contribute to final patient cost; some of which are out of the clinician's control. One piece of the patient's cost equation is the direct cost associated with the medication to be used. The purpose of this manuscript is to arm the clinician with information so that informed treatment decisions may be made with patient cost as a primary consideration as well as to evaluate the Drug Topics Red Book (Medical Economics, 2003) as a reliable reflection of retail medication costs.

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