Psoriasis is a chronic autoimmune disease that affects an estimated 4.5 million to 7.5 million Americans, costing the health care industry approximately more than $3 billion annually, according to background information in the article. The severity of the disease varies, as do the therapies—some patients with mild, localized disease can use creams or other topical agents, whereas those with more extensive disease typically require phototherapy (exposure to ultraviolet light) or systemic therapies (substances that travel through the bloodstream, such as oral medications).
Vivianne Beyer, M.D., now at St. Vincent Hospital, Indianapolis, and Stephen E. Wolverton, M.D., of the Indiana University School of Medicine, Indianapolis, constructed a cost model to analyze the current total cost of systemic therapy for psoriasis. Costs for each therapy were assessed by using the average wholesale price of each drug, as paid by third-party payers, and costs of related office visits, laboratory tests and related monitoring procedures were determined using Medicare fee schedules. Trends were analyzed by calculating the change in average wholesale price from the previous year and then were compared to the Consumer Price Index for urban areas.
"Current total and annual costs for systemic psoriasis therapies ranged from $1,197 (methotrexate [a traditional systemic therapy]) to $27,577 (alefacept [a biologic], two 12-week courses)," the authors write. Costs for phototherapy ranged from $3,083 to $7,288; for biologics, from $18,384 to $27,577.
"Trends in the average wholesale price of brand-name psoriasis therapies from 2000 through 2008 demonstrate an average increase of 66 percent (range, decrease of 24 percent to an increase of 316 percent); thus, costs of several brand-name psoriasis drugs greatly outpaced the rates of inflation for all items and all prescription drugs," they continue. In the same timeframe, the urban Consumer Price Index for all items increased 25.8 percent and for all prescription drugs, 30.1 percent.
"Although the tendency of psoriasis drug costs to outpace the Consumer Price Index-Urban rate is shared by both traditional and biologic therapies, traditional therapies remain much more affordable than biologic therapies. When considering the expense of biologic therapies, even relatively small increases in price become significant, such as the 14-percent increase during an eight-year period seen with infliximab," the authors write.
"Given the current psoriasis prescription drug market and the likely development of novel therapeutics for psoriasis in the near future, these trends are likely to continue. Thus, in addition to considerations of safety, efficacy and patient convenience and preference, health care professionals should be aware of current costs and anticipate future costs when making therapeutic decisions."