Access to psoriasis treatment in Brazil and Chile: A cross-sectional multicentre Global Healthcare Study on Psoriasis

Abstract

Background Sufficient data on access to systemic treatment for patients with psoriasis living in Latin America (LA) including Chile and Brazil are lacking. Understanding the availability and limiting factors of access to treatments can help to improve patient care and decrease long-term healthcare costs. Objective In association with the Global Psoriasis Atlas, this cross-sectional survey study analysed the availability and insurance reimbursement of systemic treatments for adult psoriasis patients in Brazil and Chile. Methods A multi-centre, cross-sectional ‘Global Healthcare Study on Psoriasis’ (GHSP) was performed in Brazil and Chile in 2020. For each eligible adult psoriasis patient, doctors and nurses completed a 48-item questionnaire about clinical aspects of psoriasis including the Psoriasis Area Severity Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI), as well as the availability of systemic treatments and insurance reimbursement status. Between-country differences were compared with Wilcoxon rank sum tests for continuous variables, and a chi-square test, or Fisher´s exact test where appropriate, for categorical variables. The median and inter-quartile range (IQR) was calculated for non-normal distributed data. Results A total of 1,424 psoriasis patients from 43 centres, 27 centres in Brazil (n = 826) and 16 in Chile (n = 598), were included with a mean age of 49.1 years (±16.3) and 49.2 years (±15.1) respectively. Unstratified analyses revealed that psoriasis patients in Chile had more severe disease than those in Brazil (PASI 11.7 vs. 8.4 (p < 0.001) and BSA 14.7 vs. 12.0 (p = 0.003) respectively). For patients with moderate-to- severe psoriasis, defined as PASI and/or BSA ≥ 10, systemic non-biologic drugs were available (81.2% in Brazil and 65.3% in Chile, p ≤ 0.001), but only 37.0% of patients in Brazil and 27.3% in Chile received biologics (p = 0.01). Lack of availability and/or lack of insurance reimbursement for biological drugs for moderate-to-severe psoriasis patients was reported for 22.2% (50 out of 357) in Brazil and 67.9% (148 out of 300) in Chile (p < 0.001). Patients with no access to biologic therapies due to lack of availability/insurance reimbursement had a median PASI of 9.15 (IQR 3.00, 14.25) in Brazil and 12.0 (IQR 5.00, 19.00) in Chile (p = 0.007), as well as a median BSA of 7.0 (IQR 3.00, 15.00) and 12.0 (IQR 5.00, 22.50) (p = 0.002), and median DLQI of 11.0 (6.00, 15.00) and 21.0 (6.50, 25.00) (p = 0.007) respectively. Conclusion Chilean patients had significantly more severe psoriasis compared to Brazilian patients in our study. While non-biologic treatments for moderate-to-severe psoriasis were available in both Latin American countries, there is a high need for an improvement in access to more effective psoriasis treatment including biologics. Our results highlight a significant gap between treatment recommendations in international psoriasis guidelines and real-world situations in Brazil and Chile.

Correlation between Dermatology Life Quality Index and Psoriasis Area and Severity Index in Patients with Psoriasis: A Cross-sectional Global Healthcare Study on Psoriasis

“…Despite the fact that skin clearance with different psoriasis treatments often seems to be associated with greater quality of life (18), a better understanding of regional differences in disease-specific quality of life worldwide is needed to optimize treatment in a personalized way. Better access to appropriate treatment in some geographical regions (21) may improve the burden of disease globally. The regression coefficients are larger for higher quantiles, indicating that a reduction in PASI could result in a considerable improvement in the quality of life of patients.…”

“…The Global Healthcare Study on Psoriasis (GHSP) is a multi-country, multi-centre, longitudinal observational study that collects cross-sectional data. This research project is an ongoing international, global survey performed since January 2020 in multiple countries across several continents ( 15 , 21 ). Socio-demographic and psoriasis-related disease and treatment data were obtained from 2 specialized dermatology centres in Europe (Switzerland), 31 in Latin America (Brazil and Chile), 4 in Asia (China and Singapore), and 1 in North America (USA).…”