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

Methods

A list of common psoriasis medications was generated and each medication was divided into various categories for comparison: systemics/biologics, topical noncorticosteroids, and topical corticosteroids, which were further subdivided into potency classes I-VI (based on commonly accepted vasoconstrictor assay properties) (Barry & Woodford, 1975). Prices from the 2003 Drug Topics Red Book as well as the Internet pharmacy drugstore.com were used in tabulating cost information (Medical Economics, 2003; drugstore.com, 2004). Price data were entered into a database (Microsoft Excel, Microsoft Corporation, Redmond, WA).

The Red Book reports average wholesale price (AWP) and this figure is intended to represent the average acquisition price that physicians, pharmacies, and other customers pay to wholesalers. The Red Book reports the AWP based on "data obtained from manufacturers, distributors, and other suppliers." A given medication may have multiple AWPs listed, each corresponding to a different manufacturer and/or distributor. When multiple listings were present, a mean AWP was calculated for a given preparation. Prices from drugstore.com are based on the largest dispensed quantities listed and were obtained on September 4th, 2003.

For systemic/biologic medications, a "typical" dose was selected. The doses evaluated were methotrexate, 15 mg per week; acitretin, 25 mg per day; and cyclosporine, 350 mg per day. Monthly cost estimates were created based on these doses. For the topical medications, monthly cost estimates were based on an 18 g supply; this represents a typical 1 month supply for a patient with approximately 1% BSA involvement. Although 18 grams may be an insufficient amount, by reporting cost per 1% body surface area (BSA), we facilitate calculation of cost for patients with more extensive involvement. For example, for a patient with 10% BSA, the cost per month can be multiplied by 10 to calculate a monthly estimate.

In reporting price per class among topicals, the price per 18 grams was averaged for all medications in the respective class. If there were multiple prices for the same medication from different suppliers, the costs were averaged. Class VII corticosteroids have not been included because most are available over-the-counter, allowing for patients to do their own price comparison. Class VII corticosteroids are defined as topical preparations with hydrocortisone, dexamethasone, flumethasone, prednisolone, or methylprednisolone.

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