78
Evaluating the Economic Burden of Psoriasis
in the United States
Vanderpuye-Orgle, J1; Zhao, Y2; Lu, J2; Shrestha, A1; Sexton, A1; Chan, D1; Seabury, S3
(Please see authors’ affiliations on the last panel)
Background
• Approximately 3.2% of the United States (U.S.) population are affected by psoriasis,1
and about 25% of them suffer from moderate-to-severe psoriasis.2
• Psoriasis leads to direct medical costs and indirect costs due to factors such as leave of
absence, lower productivity, disability, discrimination, and impaired quality of life.3,4,5
• Although some of these cost components have been studied, the total social and
economic burden of psoriasis in the U.S. has yet to be fully aggregated and quantified.6
Study Design
Study Objectives: To estimate the total economic burden of psoriasis in the U.S.
Study Design: A systematic literature review with a final data aggregation step to calculate a
national-level, comprehensive burden estimate.
Study Flow Diagram
Citations collected from broad
database searches
N = 3,737a
Unique titles screened
N = 3,692
Abstracts screened
N = 1,541
Excluded studiesb
N = 45
Duplicate citations (100%)
N = 2,151
Not relevant to study objectives (100%)
N = 1,220
 Does not contain outcomes of interests (47%)
 Is not an original research study (36%)c
 Was not conducted in the U.S. (24%)d
 Does not involve psoriasis/psoriatic arthritis patients (2%)
Full-text screen
N = 321
 Clinical trial or RCT (<1%)
 Was published before 2003 (<1%)
N = 230
Included
N = 91
 Not conducted in the U.S. (80%)d
 Not an original research study (20%)c
 Does not contain outcomes of interests (6%)
a PubMed
yield = 3,663; Cochrane yield = 74
Percentages are calculated using excluded studies in each level as the denominator
c Systematic reviews flagged for hand-screening citations: 58 in the abstract screen; 3 in the full-text screen
d Non-U.S. studies flagged for investigation if necessary: 261 in the abstract screen; 166 in the full-text screen
b
Data and Methods
Data: Estimates for prevalence, incremental medical costs, productivity loss, and reductions
in health-related quality of life (HRQoL) associated with U.S. psoriasis patients were extracted
from peer-reviewed journal articles published from January 2003 to June 2013.
Overview of Methods:
• 2013 prevalence estimate: Calculated based on the most recent representative prevalence
(2001) and incidence (1999) rates published. Annual prevalence cases for 2001-2013 were
sequentially estimated by adding incidence cases to prior year prevalence and subtracting
annual number of deaths in the psoriasis population based on U.S. mortality rates.
• Incremental costs: Calculated using estimates from studies that compared medical costs of a
psoriasis group with a control group. All per patient per year costs were adjusted to 2013
dollars and the total costs were calculated using the estimated prevalence rate.
• Productivity loss: Estimated by summing estimates of presenteeism, absenteeism, and
unemployment related costs. Presenteeism was measured using mean output demand scale (a
scale from 0%-100% validated with actual productivity loss data) from the Work Limitations
Questionnaire instrument. Absenteeism was measured using number of workdays missed due
to poor health or doctor visits, and unemployment cost was measured by combining the
estimate of unemployed psoriasis patients (ages ≥ 18) with average U.S. annual income.
• Reductions in HRQoL: Calculated using studies with Short Form Health Survey 12 scores for a
psoriasis group and a control group and mapping the scores to a quality-adjusted life year
(QALY) dollar value of $40,000.
Psoriasis Was Estimated to Affect Over Seven Million Americans
in 2013
2013 estimate of psoriasis prevalence among U.S. adults (≥ 18)
Population
Total U.S. populationb
Prevalence cases
(% of total U.S. population)a
% of total psoriasis
population
242,556,624
(100.00%)
--
7,372,990
(3.04%)
100.00%
6,139,489
(2.53%)
83.27%
Moderate
842,733
(0.35%)
11.43%
Severe
390,768
(0.16%)
5.30%
Male
3,584,010
(1.48%)
48.61%
Female
3,788,980
(1.56%)
51.39%
6,487,816
(2.67%)
87.99%
885,174
(0.36%)
12.00%
Total psoriasis cases
Psoriasis by severity
Mild
Psoriasis by gender
Psoriasis by race/ethnicity
White
Non-white
a
Based on the prevalence rate reported by Stern et al (2004), and incidence growth and incidence rates reported by Icen et al (2009). The average mortality rate was
calculated from the mortality data for 2004-2011 from CDC FASTSTATS death and mortality.9-11
b
The population estimate for 2013 is from the Census population clock accessed on November 5, 2013.12
Annual Economic Burden of Psoriasis in the U.S. Was Estimated
at $47.2 Billion in 2013
Annual economic burden estimate based on 2013 psoriasis population
Per patient burden
Total U.S. burden
($/patient/year)
($billions/year)
Total medical costsa
Total healthcare costs from payer
1,757
12.9
527
3.9
2,284
16.8
2,203
16.2
Presenteeismc
728
5.3
Absenteeismc
463
3.4
Unemploymentd
743
5.5
Total productivity costs
1,935
14.2
Total psoriasis burden
6,422
Total out-of-pocket costs
Total medical costs
Quality of Lifeb
Mental health & physical health
Productivity
a
47.2
7
All costs were adjusted to 2013 dollars based on medical-related consumer price index from the BLS. Healthcare cost reflects incremental cost of psoriasis patients
compared with patients without psoriasis.
b
Costs related to quality of life were estimated using a quality adjusted life year (QALY) value of $40,000 and QALY utility weights from Sullivan and Ghushchyan (2006)8
c
Estimated costs were from Allen, Bunn and Naim (2012), and the methodology was adapted from Schmitt and Ford (2006)4, 13
d
Estimated costs were based on Ciocon, Horn, and Kimball (2008) and Pearce et al (2006)14, 15
Conclusions
• A total of 7.4 million people were estimated to be living with psoriasis in the U.S. in 2013.
• A total burden of psoriasis was estimated to be $47.2 billion annually, including both
direct and indirect costs.
• Direct healthcare costs totaled $16.8 billion, while indirect costs resulting from reduced
quality of life and loss of productivity was $30.4 billion. Compared with other chronic diseases
such as diabetes, a larger proportion (approximately two-thirds) of the total burden of
psoriasis was due to either reduced productivity or diminished quality of life.
References
1.
Kurd SK, Gelfand JM. The prevalence of previously diagnosed and undiagnosed psoriasis in U.S. adults: results from NHANES 2003-2004. Journal
of the American Academy of Dermatology. 2009;60(2):218-24. Epub 2008/11/22.
2.
National Psoriasis Foundation. Statistics. 2013 [cited 2013 Nov 13]; Available from: https://www.psoriasis.org/learn_statistics.
3.
Fowler, JF. The impact of psoriasis on health care costs and patient work loss. J Am Acad Dermatol, 2008. 59(5): p. 772-80.
4.
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. Dermatology, 2006. 213(2): p. 102-10.
5.
Wu Y, Mills D, and Bala M. Impact of psoriasis on patients' work and productivity: a retrospective, matched case-control analysis. Am J Clin
Dermatol, 2009. 10(6): p. 407-10.
6.
Helmick CG. Psoriasis and psoriatic arthritis: a public health agenda. Am J Prev Med, 2013. 44(4): p. 424-6.
7.
Bureau of Labor Statistics. Consumer Price Index. 2013 [cited 2013 October 13]; Available from:
http://data.bls.gov/timeseries/CUSR0000SAM?output_view=pct_1mth.
8.
Sullivan PW and Ghushchyan V. Preference-Based EQ-5D index scores for chronic conditions in the United States. Med Decis Making . 2006;26(4):
410-420.
9.
Stern RS, Nijsten T, Feldman SR, Margolis DJ, Rolstad T. Psoriasis is common, carries a substantial burden even when not extensive, and is
associated with widespread treatment dissatisfaction. The journal of investigative dermatology Symposium proceedings / the Society for
Investigative Dermatology, Inc [and] European Society for Dermatological Research. 2004;9(2):136-9.
10. Icen M, Crowson CS, McEvoy MT, Dann FJ, Gabriel SE, Maradit Kremers H. Trends in incidence of adult-onset psoriasis over three decades: a
population-based study. Journal of the American Academy of Dermatology. 2009;60(3):394-401.
11. CDC. FastStats A to Z. 2014 [cited 2014 Jan 13]; Available from: http://www.cdc.gov/Nchs/fastats/.
12. United States Census Bureau. U.S. and World Population Clock. 2014 [cited 2013 Nov 5]; Available from: https://www.census.gov/popclock/.
13. Allen H, Bunn WB, 3rd, Naim AB. The self-reported health and productivity burden of autoimmune disorders at a major self-insured employer.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. 2012;54(9):1049-63. Epub
2012/08/30
14. Ciocon DH, Horn EJ, Kimball AB. Quality of life and treatment satisfaction among patients with psoriasis and psoriatic arthritis and patients with
psoriasis only : results of the 2005 Spring U.S. National Psoriasis Foundation Survey. American journal of clinical dermatology. 2008;9(2):111-7.
Epub 2008/02/21.
15. Pearce DJ, Singh S, Balkrishnan R, Kulkarni A, Fleischer AB, Feldman SR. The negative impact of psoriasis on the workplace. The Journal of
dermatological treatment. 2006;17(1):24-8. Epub 2006/02/10.
Author Affiliations
1Precision
Health Economics, Los Angeles, CA, United States
Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
3 University of Southern California, Los Angeles, CA, United States
2
This study was sponsored by Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
Disclosures: Y. Zhao, Novartis Pharmaceuticals Corporation; J. Lu, was a fellow of Novartis Pharmaceuticals Corporation when the study was
conducted.