Moderate and severe plaque psoriasis: cost-of-illness study in Italy

Abstract

Psoriasis is a chronic infl ammatory, immune-mediated skin disorder that affects 1.5-1.8 million people in Italy. The most common form of the disease is chronic plaque psoriasis, affecting about 90% of psoriasis patients, with about 20%-30% of them suffering from a moderate or severe condition. Little information is available about the economic impact of psoriasis in European countries. The primary objective of this study was to perform a cost-ofillness analysis of patients with moderate and severe plaque psoriasis in Italy. Therefore, direct, indirect costs, and intangible costs (quality of life -QoL) were assessed. In this national, multicenter, prospective, 3-month cost-of-illness study of moderate and severe plaque psoriasis, direct and indirect costs were assessed from the patient, third-party payer (National Health Service, NHS), and societal perspectives. From November 2003 to October 2004 consecutive patients were enrolled over a 1-year period, in order to minimize seasonal fl uctuations in disease severity. 150 patients enrolled in 6 investigational sites in Italy, completed the study, and were eligible to be analyzed according to the study protocol. Intangible costs (QoL) were measured using SF36 and DLQI questionnaires. The mean total cost for psoriasis (average Psoriasis Area Severity Index [PASI] score 21.4), including direct and indirect items, was 8,371.61 per patient per year. The mean cost for patients with moderate disease (PASI Յ 20) was 5,226.04, while the mean cost for patients with more severe disease (PASI Ͼ 20) was 11,434.40 per year. Disease heavily affected QoL measured using SF36, and the impairment was greater in patients affected by a more severe form of disease. Moderate and severe plaque psoriasis is associated with extremely high costs, which are related to disease severity. Data from this study show that the more severe plaque psoriasis, the higher the direct and indirect costs for its management. Direct costs are higher than indirect costs; hospitalization represents the most signifi cant item, accounting for 30% of the total expenses. QoL in moderate and severe plaque psoriasis is low compared with the population at large, confi rming the high impact of plaque psoriasis on QoL. The relatively high average annual costs per patient point to the need for a more effi cient and long-term control of psoriasis.

Coste de la psoriasis y artritis psoriásica en cinco países de Europa: una revisión sistemática

“…La perspectiva social se utilizó en todos los estudios, a excepción de 2, que utilizaron la perspectiva del sistema sanitario 24,25 . El método de capital humano se empleó para valorar los costes indirectos en 3 publicaciones 22,26,27 , mientras que una utilizó el método de costes de fricción 28 . El resto de publicaciones que utilizaron la perspectiva social no especificaron el método de cálculo de costes indirectos empleado.…”

“…El resto de publicaciones que utilizaron la perspectiva social no especificaron el método de cálculo de costes indirectos empleado. El horizonte temporal varió de 3 24,27 a 12 meses 22,23,25,27,29,30 . En 6 de las 10 publicaciones se seleccionaron pacientes con Ps de moderada a grave 23,25---28,31 , y solo 3 de ellas utilizaron herramientas como el Psoriasis Area Severity Index y/o el Body Surface Area 26---28 .…”

Effectiveness End Points in Real-World Studies on Biological Therapies in Psoriasis: Systematic Review with Focus on Drug Survival

“…Psoriasis causes considerable morbidity and significantly reduces quality of life due to psychological distress, depression, and disability [1]. For these reasons it is considered an important social disease [2], with a relevant economic impact, principally due to direct costs of its management and loss of productivity [3]. …”

Cost-utility of secukinumab in Italian patients with moderate to severe plaque-type psoriasis

“…Almost 1.5 million of Italians are suffering from psoriasis; of those, 90% is affected by chronic plaque-type psoriasis with 20-30% diagnosed as moderate-to-severe (11). A 10% of such patients may need hospitalization due to their disease (7,12). Traditional systemic agents available in Italy for the treatment of moderate-to-severe psoriasis include cyclosporin, methotrexate and oral retinoids.…”