Abstract
Treatment modalities of chronic plaque psoriasis have dramatically changed over the past ten years with a still continuing shift from inpatient to outpatient treatment. This development is mainly caused by outpatient availability of highly efficient and relatively well-tolerated systemic treatments, in particular BioLogicals. In addition, inpatient treatment is time- and cost-intense, conflicting with the actual burst of health expenses and with patient preferences. Nevertheless, inpatient treatment with dithranol and UV light still is a major mainstay of psoriasis treatment in Germany. The current study aims at comparing the total costs of inpatient treatment and outpatient follow-up to mere outpatient therapy with different modalities (topical treatment, phototherapy, classic systemic therapy or BioLogicals) over a period of 12 months. To this end, a retrospective cost-of-illness study was conducted on 120 patients treated at the University Medical Centre Mannheim between 2005 and 2006. Inpatient therapy caused significantly higher direct medical, indirect and total annual costs than outpatient treatment (13,042 € versus 2,984 €). Its strong influence on cost levels was confirmed by regression analysis, with total costs rising by 104.3% in case of inpatient treatment. Patients receiving BioLogicals produced the overall highest costs, whereas outpatient treatment with classic systemic antipsoriatic medications was less cost-intense than other alternatives.
Highlights
Psoriasis is a chronic inflammatory disease affecting about 2% of the population in Europe and Northern America
In the US, moderate to severe psoriasis is mostly treated in an outpatient setting [7,8], while in Germany and other European countries inpatient treatment, mostly conducted as a regimen of topical dithranol combined with UV light, still is a common, but expensive therapeutic alternative [9,10,11,12]
Detailed information on duration and frequency of in- and outpatient treatment and visits, prescribed treatments, diagnostic procedures and sick certificates was collected from the medical records, together with medical information such as Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), presence or absence of psoriatic arthritis and co-morbidities
Summary
Psoriasis is a chronic inflammatory disease affecting about 2% of the population in Europe and Northern America. In the US, moderate to severe psoriasis is mostly treated in an outpatient setting [7,8], while in Germany and other European countries inpatient treatment, mostly conducted as a regimen of topical dithranol combined with UV light, still is a common, but expensive therapeutic alternative [9,10,11,12]. This regimen is increasingly being replaced by highly effective outpatient alternatives, in particular by biologicals [4,13,14,15,16].
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