The estimated total direct and indirect health care cost of psoriasis in the United States is 11.25 billion dollars annually, with direct medical costs estimates ranging from 650 million to 4.3 billion dollars. 8,9 The cost of psoriasis in the United States is multidimensional. Total cost includes medical and prescription drug costs, patient expenditures, lost work time, reduced productivity, and diminished quality of life. In a case comparison of 56,528 patients with psoriasis versus the general population, patients with psoriasis had significantly greater health care resource use ($5529 vs $3509), higher total drug use ($1604 vs $822), and greater overall medical costs ($3925 vs $2687).
Epidemiologic studies show that the psychosocial burden of psoriasis is one of the most challenging aspects of disease management. 11 Psoriasis affects daily activities of living for nearly 60% of patients, especially in women, younger patients, and those afflicted with moderate-to-severe psoriasis. 7,12 Psychosocial consequences of having psoriasis include decreased self-esteem and stigmatization in social relations and employment. In a questionnaire given to 17,350 patients with psoriasis, as many as two-thirds of patients report that the disease has limited their daily activities in areas such as sleeping, sexual activity, use of hands, walking, sitting for long periods of time, and performing job duties.
Psoriasis is also related to decreased sexual intimacy and decreased libido in 30% to 70% of patients. 17,18 In a study conducted by Gupta and Gupta, 17 40.8% of 120 patients surveyed reported that the disease impacted their sexual activity. The affected group also reported more joint pains, greater area of scaling, and greater pruritus severity. In addition, psoriasis patients had higher depression scores. A recent study has suggested that these comorbidities may contribute to decreased sexual functioning in psoriasis patients.
Psoriasis is associated with comorbid conditions, including depression, arthritis, diabetes, hypertension, metabolic syndrome, and cardiovascular events. These comorbid conditions may occur concurrently or years after development of psoriasis.
Pearce and colleagues110 examined the cost-effectiveness of psoriasis treatments over a 12-week period comparing methotrexate, acitretin, cyclosporine, narrow band UV-B, PUVA, etanercept, and efalizumab. The total cost per completed treatment regimen was calculated based on drug acquisition costs, dosing and cost of physician visits, laboratory testing, phototherapy treatment charges, liver biopsy, and infusions charges. The total cost for a 12-week completed treatment was $3921 for PUVA, $2658 for UV-B, $436 for methotrexate, $1419 for acitretin, $2464 for cyclosporine, $4299 for efalizumab, and $7993 for etanercept. The cost-effectiveness for a 12-week completed treatment was $623 for methotrexate, $2729 for acitretin, $3692 for narrow band UV-B, $4668 for PUVA, $16,323 for etanercept, and $17,196 for efalizumab.