Under-Treatment of Patients with Moderate to Severe Psoriasis in the United States: Analysis of Medication Usage with Health Plan Data

Abstract

IntroductionPsoriasis is a chronic inflammatory disorder with significant morbidity and mortality, but a persistent gap appears to exist for the adequate treatment of patients with moderate to severe disease. As the extent of under-treatment is unknown, we attempted to determine overall treatment patterns and estimate under-treatment using a large database.MethodsData from the US National Health and Wellness Survey was used to estimate the proportion of patients with mild, moderate or severe psoriasis. The proportion with moderate to severe disease was estimated by excluding those with mild disease, and projecting this to the total insured US population, weighted by age and gender. Using US health plan claims data, patient totals by treatment type were determined between October 1, 2007 and September 30, 2012. Patients had to be continuously enrolled in a health plan and be ≥18 years at the end of the analysis window. Psoriasis was confirmed if patients had at least one claim of any type of psoriasis except psoriatic arthropathy (ICD-9 code 696.1). A monthly treatment history, classified by biologic, traditional oral systemic, phototherapy and topical therapy, was recorded for each patient.ResultsThere were an estimated 1.7 million insured US patients with moderate to severe psoriasis. Of these, 1 million (59%) were not treated for their condition in the preceding year. Among 695,488 patients who were treated for psoriasis in the preceding year, 346,201 were currently receiving treatment and 349,287 had lapsed treatment. Of the patients lapsed and currently treated in this period, the numbers who received each treatment type were 156,409 (biologic), 222,657 (traditional oral systemic), 22,911 (phototherapy), and 293,511 (topical). A limitation of the study was that only insurance claims were analyzed.ConclusionModerate to severe psoriasis remains persistently untreated or under-treated. We suggest that potential barriers preventing access to care be explored.FundingThis study was sponsored by Pfizer Inc.

Patient perceptions of clear/almost clear skin in moderate‐to‐severe plaque psoriasis: results of the Clear About Psoriasis worldwide survey

“…Studies have indicated that 20-32% of patients with moderate-to-severe psoriasis are not receiving any therapy, 26,27 and undertreatment is common, with substantial proportions of moderate (19-30%) and severe (22-33%) psoriasis patients receiving topical treatments only. This statistic underscores the variability in psoriasis care delivery among healthcare providers and potential knowledge or access gaps that need to be addressed.…”

“…The difficulty that patients reported in finding effective therapy is consistent with recent data on the suboptimal treatment of psoriasis. Studies have indicated that 20-32% of patients with moderate-to-severe psoriasis are not receiving any therapy, 26,27 and undertreatment is common, with substantial proportions of moderate (19-30%) and severe (22-33%) psoriasis patients receiving topical treatments only. 14,27 High proportions of survey respondents indicated that their disease resulted in discrimination or humiliation in daily life and negative consequences for work and personal relationships.…”

Comparative cost-effectiveness of tildrakizumab and other commonly used treatments for moderate-to-severe psoriasis

“…Psoriasis is a chronic, relapsing, and systemic inflammatory skin disease that affects approximately 7.4 million adults in the United States (US) (1), with plaque psoriasis accounting for more than 80% of cases (2). According to an estimation based on data from the US National Health and Wellness Survey from 2007 to 2012, 1.7 million insured US patients have moderate-tosevere plaque psoriasis (3). Moderate-to-severe psoriasis is associated with a considerable disease burden, affecting patients' physical and psychological wellbeing and resulting in reduced quality of life and work productivity (4)(5)(6)(7).…”

Defining and treating moderate plaque psoriasis: a dermatologist survey

“…Significant barriers exist that often lead to undertreatment of many patients with moderate psoriasis, with resulting unsatisfactory clinical outcomes (1)(2)(3)(4)(5). Of importance, there appears to be a lack of consensus on how to identify and appropriately treat patients with moderate psoriasis.…”

“…Likewise, treatment strategies that specifically address the needs of patients with moderate psoriasis have not been developed. Most patients with moderate psoriasis or moderate to severe psoriasis continue to receive no therapy or topical treatments alone, despite lack of symptom relief (1,2,5).…”