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Burden of disease


considerable clinical burden and necessitates consistent and long-term management. To provide appropriate management of psoriasis from an early stage, it is necessary to include prompt diagnosis of concomitant disease and to prevent and treat any comorbidity found.8 An integrated approach is necessary, to ensure that the drugs used to treat associated diseases do not interfere with the management of psoriasis, and vice versa.


Economic and wider societal impact of psoriasis


Psoriasis also has an economic burden, both on the individual and on society. From a personal point of view, this condition may influence major life decisions, such as the choice of job. Employment opportunities can be reduced, with negative consequences on income. In a study,9


48% of patients with


severe psoriasis and not working full time reported that their disease was the main reason for not working. However, there is also a burden on society, in terms of loss of workdays and productivity. It has been shown that psoriasis patients are more likely to miss work, have significantly more health-related work productivity impairment, and more overall work impairment than non-psoriasis patients.10 A British study found that nearly 60% of patients reported missing an average of 26 days per year directly related to their psoriasis.11


Other studies showed that, on


average, 2.2 hours were lost from work per week owing to psoriasis-related events,12 and that patients missed an average of 6.6% of their working time in the previous four weeks as a result of their psoriasis. It is well known that treatments and hospitalisations for psoriasis have a high cost, but it has been shown that the indirect costs of productivity loss can even exceed these direct costs.13


In the economic evaluation, the aspect of quality of life is essential. It has been reported14


that healthcare resource


utilisation by European patients with plaque psoriasis, in terms of


dermatologist visits and hospitalisations, was greater for those with poorer quality of life, independent of clinical disease severity, and may decrease if quality of life improved. The same study also found that poor quality of life was associated with employment disadvantages, even when controlling for disease severity, suggesting that indirect costs of psoriasis may also be augmented for patients who have a poor quality of life. This is not


surprising, as it is well known that clinical severity and quality of life are not linearly associated,15


and that a patient with a low


clinical severity may experience a high impact on quality of life.


Concerning pharmacoeconomics, three types of cost–benefit analysis are possible: ● Cost versus symptomatic improvement [for example, Psoriasis Area and Severity Index (PASI)]: cost-effectiveness analysis


● Cost versus an outcomes cost improvement (for example, an early treatment may avoid the costs associated with the disease progression): cost–benefit analysis


● Cost versus an improvement in quality of life: cost–utility analysis


Conclusions


Psoriasis is a multifaceted condition with several implications for the personal and social life of affected people. It has heavy direct and indirect costs. The frequent presence of comorbidities makes the management of the disease particularly complex. The choice of treatment has to take into account all these aspects, with a reasonable balance between costs and effectiveness. ●


References 1. Naldi L. Scoring and monitoring the severity of psoriasis. What is the preferred method? What is the ideal method? Is PASI passé? facts and controversies. Clinics in Dermatology 2010;28:67–72.


2. Kimball AB et al. Psoriasis: is the impairment to a patient’s life cumulative? J Eur Acad Dermatol Venereol 2010;24:989–1004.


3. Testa M and Simonson D. Current concepts: assessment of quality of life outcomes. N Engl J Med 1996;334:835–40.


4. Rapp SR et al. Psoriasis causes as much disability


as other major medical diseases. J Am Acad Dermatol 1999;41:401–7.


5. Sampogna F et al. Measuring quality of life of patients with different clinical types of psoriasis using the SF-36. Br J Dermatol 2006;154:844–9.


6. Ginsburg IH and Link BG. Feelings of stigmatization in patients with psoriasis. J Am Acad Dermatol 1989;20:53–63.


7. Nijsten T and Wakkee M. Complexity of the Association Between Psoriasis and Comorbidities. J Invest Dermatol 2009;129:1601–3.


8. Daudén E et al. Clinical practice guideline for an integrated approach to comorbidity in patients with psoriasis. J Eur Acad Dermatol Venereol 2012; [Epub ahead of print].


9. Horn EJ et al. Association of patient-reported psoriasis severity with income and employment. J Am Acad Dermatol 2007;57:963–71.


10. Wu Y et al. Impact of psoriasis on patients’ work and productivity: a retrospective, matched case-control analysis. Am J Clin Dermatol 2009;10:407–10.


11. Finlay AY and Coles EC. The effect of severe psoriasis on the quality of life of 369 patients. Br J Dermatol 1995;132:236–44.


12. Chan B et al. Work-related lost productivity and its economic impact on Canadian patients with moderate to severe psoriasis. J Cutan Med Surg 2009;13:192–7.


13. Schmitt JM and Ford DE. Work limitations and productivity loss are associated with health- related quality of life but not with clinical severity in patients with psoriasis. Dematology 2006;213:102–10.


14. Sato R et al. Health-related quality of life and healthcare resource use in European patients with plaque psoriasis: an association independent of observed disease severity. Clin Exper Dermatol 2010;36:24–8.


15. Sampogna F et al. Measures of clinical severity, quality of life, and psychological distress in patients with psoriasis: a cluster analysis. J Invest Dermatol 2004;122:602–7.


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