Psoriasis Costs United States Up to $135 Billion a Year

Marcia Frellick

January 08, 2015

The costs for managing patients with psoriasis in the United States totaled between $112 billion and $135 billion in 2013, according to a new study. The economic burden is particularly significant because the disease has considerable physical, psychiatric, and social consequences.

The researchers broke down costs this way: direct costs, $51.7 billion to $63.2 billion; indirect costs (related to absenteeism or working while sick), $23.9 billion to $35.4 billion; medical comorbidities, $36.4 billion. They also estimated a one-time cost of up to $11,498 per patient for intangible costs (to eliminate the negative effects of psoriasis in physical and mental health).

To make those estimates, Elizabeth A. Brezinski, MD, from the University of California, Davis, in Sacramento, and coauthors reviewed 22 studies published between 2008 and 2013. Their results were published online January 7 in JAMA Dermatology.

The authors note that the biggest drivers were the direct costs, including medication and other treatments, hospitalizations, laboratory work, and monitoring.

Steven Feldman, MD, PhD, professor of dermatology at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, told Medscape Medical News that drugs including adalimumab, ustekinumab, and etanercept "undoubtedly have made a big difference in our ability to get people well to a place where life is worth living, and at the same time have increased the cost considerably."

This study may raise awareness of psoriasis among insurers and boost the urgency of finding better management and less expensive treatments when possible, he said.

"I think we'll see greater efforts to encourage phototherapy," he said. Although the treatment costs less than drugs, he said, insurance companies have favored biologics.

Psoriasis can have devastating consequences. Added to skin and joint impairment are comorbidities such as increased vascular events and depression. Patients with psoriasis often struggle with social interactions and psychological distress and may need to be treated over a lifetime.

Dr Brezinski and colleagues looked at PubMed and MEDLINE databases for economic analyses on direct, indirect, comorbidity, and intangible costs of adult psoriasis in the United States, adjusted to 2013 dollars, and multiplied by the estimated number of patients with psoriasis.

"Our review shows that patients with psoriasis have significantly greater health care costs in all 4 cost sources analyzed and that the burden is driven largely by the direct costs," the authors write.

The intangible costs were the hardest to measure. A willingness-to-pay model helps gauge the influence of psoriasis on life. One study found that individual patients with psoriasis were willing to pay $1114 a year for symptom relief. That totaled $2.3 billion per year for all patients, after adjusting for severity. Another study found that patients with psoriasis were willing to pay the most for physical and emotional health ($2000 each), followed by ability to work or volunteer ($1600).

One coauthor reported serving as an investigator for or consultant to AbbVie, Amgen, Celgene, Janssen, Lilly, Merck, Pfizer, and UCB. Dr Feldman has received research, speaking, and/or consulting support from a variety of companies including Galderma, GSK/Stiefel, Leo Pharma, Baxter, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, AbbVie, Amgen, Astellas, Janssen, Lilly, Merck, Merz, Novartis, Qurient, National Biological Corporation, Caremark, Advance Medical, Suncare Research, Informa, UpToDate and National Psoriasis Foundation. He also is a founder and majority owner of www.DrScore.com and a founder and part owner of Causa Research, a company dedicated to enhancing patients' adherence to treatment.

JAMA Dermatol. Published online January 7, 2015. Abstract

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