Systemic treatment for moderate to severe psoriasis: Estimates of failure rates and direct medical costs in a north-eastern US managed care plan
Systemic treatment for moderate to severe psoriasis: Estimates of failure rates and direct medical costs in a north-eastern US managed care plan
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DOI：
10.1080/09546630510025941
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发表时间：
2005-02-01
影响因子：
2.9
通讯作者：
Russell, MW
中科院分区：
文献类型：
--
作者：
Feldman, SR;Evans, C;Russell, MW
背景：美国与牛皮癣治疗相关的医疗费用估计有限，并且往往低估了中度至重度牛皮癣的经济负担，这通常需要使用全身药物，光疗或两者兼而有之。目的：估计美国银屑病患者使用全身药物和光疗的治疗失败率和直接医疗费用。方法：使用一家大型新英格兰健康保险公司的索赔记录来获取患者水平的数据。确定了至少有一项索赔列出牛皮癣ICD-9-CM代码（696.0,- 696.1）的符合条件的患者。未接受全身治疗（甲氨蝶呤、环孢素、阿维甲素）或光疗（含或不含焦油或凡凡油、补骨脂素和紫外线A [PUVA]的紫外线B）的患者被排除。治疗失败被定义为治疗的转换、非局部治疗的增强、剂量增加后的停药或住院后的停药。医疗费用包括与药房（不包括非处方药）、机构服务（住院和门诊）和专业服务有关的费用。结果：共纳入2068例中重度牛皮癣患者。在1年的时间里，大约20%的患者经历了治疗失败。转换治疗的患者到失败的平均时间从3到6个月不等。不同治疗组的平均年药费（根据接受的初始治疗进行分类）从每位患者257美元到1992美元不等。机构和专业服务的平均年费用分别为每位患者156美元至799美元和183美元至481美元。第99百分位的年度药房和机构费用分别超过1万美元和1.8万美元。结论：采用传统全身药物或光疗治疗中重度牛皮癣，治疗失败的可能性高，经济负担大。
Background: Estimates of US medical costs related to psoriasis treatment are limited and tend to understate the economic burden of moderate to severe psoriasis, which often requires the use of systemic agents, phototherapy or both. Objective: To estimate treatment failure rates and direct medical costs associated with the use of systemic agents and phototherapy in US patients with psoriasis. Methods: Claims records from a large New England-based health insurer were used to obtain patient-level data. Eligible patients with at least one claim listing an ICD-9-CM code for psoriasis (696.0,- 696.1) were identified. Patients not receiving systemic treatments (methotrexate, cyclosporine, acitretin) or phototherapy (ultraviolet B with or without tar or petrolatum, psoralen and ultraviolet A [PUVA]) were excluded. Treatment failure was defined as a switch in therapy, augmentation with non-topical therapies, discontinuation following uptitration of dose or discontinuation following hospitalization. Medical costs included those related to pharmacy (over-the-counter medication excluded), institutional services (inpatient and outpatient) and professional services. Results: A total of 2068 patients with moderate to severe psoriasis were included in the analysis. Over a 1-year period, approximately 20% of patients experienced treatment failure. The mean time to failure among patients who switched therapy ranged from 3 to 6 months. Mean annual pharmacy costs in the various treatment groups (categorized according to initial therapy received) ranged from $257 to $1992 per patient. Mean annual costs for institutional and professional services ranged from $156 to $799 and $183 to $481 per patient, respectively. The 99th percentile annual pharmacy and institutional costs exceeded $10 000 and $18 000, respectively. Conclusion: Treatment of moderate to severe psoriasis with traditional systemic agents or phototherapy is associated with a high likelihood of treatment failure and a considerable economic burden.