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

Discussion

There are an abundance of topical agents available for treating psoriasis which, in some ways, may complicate treatment decisions. Among other factors, cost should be considered when making treatment decisions, particularly when choosing among topical corticosteroids. Although there was a direct relationship between price and increasing potency class, there was considerable variation in the prices within a given class. This allowed for some overlap in the highest price of one medication in a class and the lowest price of a medication in a higher-potency class. Noncorticosteroids, while having a lower side-effect profile with regards to atrophy, pigmentation alteration, etc., were associated with a higher cost compared to other topicals. In many cases larger quantities may be available and may represent cost savings when compared to smaller quantities of the same medication. As expected, generic corticosteroids were the most inexpensive prescription medications.

Systemic and phototherapies were associated with higher costs but may be more efficacious than topicals for moderate-to-severe plaque psoriasis. Obviously, these treatments are reserved for those with increasing physical and psychological effects from their psoriasis. In such patients, these therapies are justified. It is difficult to determine which of the systemic treatments for generalized psoriasis are most cost effective as there are monitoring costs (laboratory and office visits) and the costs of potential complications to consider.

The expense associated with biologic therapies is higher than traditional treatments, with average annual costs per patient approximately $12,000 to $20,000 for treatment with these agents. Although insurance reimbursement rates vary among companies, most will reimburse medications at or slightly below their AWP (Craze & Young, 2003). There are almost always pre-approval procedures that must be followed to insure appropriate reimbursement. Despite the expense of these treatments, they may provide a cost-effective treatment for long-term management of moderate-to-severe patients who are candidates for systemic therapy.

There are many implications for successful treatment that arise from out-of-pocket expenses to the patient. Obviously poor adherence with therapy due to expense limits a medication's utility. Patients with limited financial resources are known to prioritize medications and purchase the ones they feel are most important in a given month (Balkrishnan, Byerly, Camacho, Shrestha, & Anderson, 2001). Also, the prescribed dosing regimen may be altered in an attempt to make a medication last longer. A lack of concern for patient cost could also undermine the physician-patient relationship and further complicate care. Additionally, a recent study positively correlated patients' willingness to pay for medication with their current quality of life (QoL) (Schiffner et al., 2003). With this information on hand, a clinician may be better able to counsel patients regarding potential costs and better assess the QoL of a costly therapy.

There are inherent difficulties in reporting cost information with regards to medications. We report here only gross approximates of cost in the form of the AWP. A more accurate market price may be reflected in the online pricing as this a direct consumer cost. These figures likely differ from the cost that a patient may experience as there is considerable variation in distribution/pharmacy charges and supplemental insurance among patients. In fact, this complexity partly explains the lack of cost as a factor in decision making among many clinicians. Hopefully, the information summarized here will facilitate the consideration of cost when selecting among the many treatments available for psoriasis.

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