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The direct cost of care for psoriasis and psoriatic arthritis in the United States,☆☆,,★★

https://doi.org/10.1067/mjd.2002.119669Get rights and content

Abstract

Background: Relatively little information is available in the literature concerning the cost of psoriasis in the United States, and much of that information is out of date. Objective: The present analyses estimate the direct cost of medical care for psoriasis (including psoriatic arthritis) from a societal perspective among adults in the United States. Method and Data: The costs of hospitalizations, outpatient and physician office visits, prescription and over-the-counter (OTC) medications, and medical procedures were estimated from the literature, analysis of publicly available health databases (Health and Nutrition Examination Survey, National Hospital Discharge Survey, Medicare Public Use Files, National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Care Survey), and analysis of privately available health databases (United Health Care/Diversified Pharmaceutical Services, the Medstat Group diagnosis-related group guide, and the National Disease and Therapeutic Index). Costs were expressed as of 1997 by using Medicare and health maintenance organization reimbursement rates and wholesale drug costs. Costs of OTC medications were derived by adjusting a previous estimate in the literature for inflation in over-the-counter drugs and population increases. Results: The cost of illness for the approximately 1.4 million individuals with clinically significant disease is substantial—approximately $30.5 million for hospitalizations, $86.6 million for outpatient physician visits, $27.4 million for photochemotherapy, $147.9 million for dermatologic prescription drugs, and $357.2 million for OTC drugs, for a total direct cost of $649.6 million. Conclusion: Cost estimates from this study are substantially less than those found in previous studies ($1.09 billion and $4.32 billion after adjustment of estimates in the literature for medical inflation and population increases). This appears to be principally a result of decreases in hospitalization rates since 1979 and the valuation methodology per unit of medical services (with prior studies using “list” prices and the current study using reimbursement rates). (J Am Acad Dermatol 2002;46:850-60.)

Section snippets

Definition of psoriasis

Two International Classification of Diseases, 9th Revision (ICD-9) codes were used to identify services associated with treatment of patients with psoriasis: (1) 696.0 for psoriatic arthropathy (PSA) and (2) 696.1 for other types of psoriasis (including plaque, guttate, pustular, and erythrodermic).

There is considerable controversy in the literature concerning whether PSA is a distinct disease or simply a form of rheumatoid arthritis occurring in patients with psoriasis. Regardless, PSA was

Cost components and costing methodology

In the determination and attribution of relevant costs to psoriasis, a limited societal perspective was adopted with consideration of all direct medical costs. Indirect and intangible costs related to psoriasis are not valued in this cost-of-illness analysis. Direct medical costs are separated into the following primary components of care: hospitalization, inpatient physician services, outpatient physician visits, and prescription medications. The cost of over-the-counter (OTC) medications was

Prevalence of psoriasis

Disease point prevalence, as derived from the psoriasis rates in HANES I and US Bureau of Census data on the US resident population in 1997, is shown in Table III.

. Summary of number of adults with psoriasis in 1997 (derived from HANES I prevalence rates)

Type of conditionNo. in 1997Percent of US adult population
Clinically significant psoriasis1,437,0000.73
 Clinically significant psoriasis, currently active905,0000.46
 Clinically significant psoriasis, in remission532,0000.27
Not clinically

Discussion

Among the adult US population in 1997, the prevalence of clinically significant psoriasis from HANES I was 0.73% and the prevalence of all psoriasis was 1.18%. The prevalence of patients with two or more treatments for psoriasis in the last 1.8 years from UHC/DPS data is 1.06%, which appears to be generally consistent with data from HANES I. Estimates on the prevalence of psoriasis in the literature range from 0.5% to 4.6%,9 with most estimates in the range of 1.0% to 2.0%.10, 11 Koo12

Acknowledgements

We extend our appreciation to Heather Patterson, formerly of SmithKline Beecham, for her efforts in assembling the data necessary for some analyses.

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Funding sources: A grant from SmithKline Beecham.

Conflict of interest: None.

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Reprint requests: Harold S. Javitz, PhD, Center for Health Sciences, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025.

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