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Abstract
Background There is a need for more detailed information on the resource use across different cost components for patients with psoriasis alone (PSO) and psoriasis patients with psoriatic arthritis (PsA) from a population-based perspective, especially after the introduction of biological treatment for these groups.
Objectives To study annual incremental societal costs for patients with PSO and PsA compared to population-based referents free from PSO and PsA years 2008-2011.
Methods Patients of any age were identified by ICD-10 codes associated with PSO and PsA using information from 1998 to 2007 in the Skåne Healthcare Register (SHR), which covers all healthcare utilization by the Skåne Region population (total N=1.2 million 2011). For each included PSO/PsA patient, three population-based referents, matched for age, sex and residential area, were selected. Data included demographics, all-cause healthcare utilization by cost components (primary care, secondary outpatient care, and inpatient care) and caregivers (physician, nurse, physiotherapist, other), drugs and productivity losses. Resource use and costs were retrieved from SHR (healthcare), Swedish Prescribed Drug Register (drugs) and Social Insurance Register (productivity losses). We calculated the mean annual cost per patient over four years (2008-2011) adjusted for cases and referents dropping out of the study (relocation from the region or death). The human capital method was used to value productivity losses. Costs were assessed from a societal perspective and expressed in Euros (2011 prices). Differences in costs were tested by Students t -test. A P-value less than 0.05 was considered statistically significant.
Results We identified 15 283 patients (51% women, mean age (SD) 52 (19)) who fulfilled the inclusion criteria for PSO (n=12 562, 50% woman, mean age 52 (20)) or PsA (n=2 721, 56% women, mean age 54 (16)) and included 45 849 referents. Mean annual societal cost per patient with PSO and PsA was 56% higher compared to referents, € 11 146 vs. € 7 132 (p<0.001). The cost was 84% higher for PsA compared to PSO, € 17 853 vs. € 9 693 (p<0.001). Costs due to productivity losses represented the largest share of the annual mean societal costs in all groups with the highest share for PsA (59%). Almost 25% of the costs were attributable to inpatient care for individuals with PSO and referents. The corresponding figure for PsA was 12%. Annual mean drug cost represented 15% (biologics 10%) of the costs for PsA. The corresponding figures for PSO was 9% (biologics 1.5%) and for referents 7% (biologics <1%).
Conclusions The annual mean incremental societal cost per patient was highest for PsA, mainly due productivity losses and biological treatment. Patients with PSO had higher costs for inpatient care compared to PsA patients. The impact of comorbidities on these costs should be further studied.
Disclosure of Interest None declared