Abstract

The Psoriasis Area and Severity Index (PASI) is a psoriasis severity measurement tool used by clinicians, which evaluates different regions of the body and rates the corresponding psoriatic lesions based on their level of erythema, induration and scaliness. It is a highly quantitative method that has been used by some insurance companies to establish minimum requirements for approval of the biologic therapeutics alefacept (Amevive), efalizumab (Raptiva) or etanercept (Enbrel) for psoriasis. A large insurance company proposed a minimum PASI score of 10 to justify reimbursement for biologic therapies. However, calculating the PASI score was burdensome. We hypothesized that the method of calculating percentage of body surface area (BSA) affected would be easier and more time-efficient, and thus could serve as a suitable proxy for the PASI score. We analyzed the BSA percentages and corresponding PASI scores in 96 patients whose psoriasis was prospectively graded in clinical trials. We hypothesized that BSAs of 10% to 15% correlated to a PASI of 10, the threshold score for the insurance company to authorize the use of the biologics. Our results show that with a minimum BSA involvement of 13%, only two out of 15 patients had PASI scores less than 10, and both of those patients had PASI scores greater than 9. Like the PASI score, BSA is an imperfect tool for the assessment of psoriasis severity, but it is much easier to use than the PASI score.

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