Costs and Burdens of Psoriasis

Amy McMichael, MD, and Maria Lopes, MD, MS, review the major differences in quality of life, the impact on patients, and the costs and burdens associated with absenteeism or presentism.

Ryan Haumschild, PharmD, MS, MBA: You talked a lot about emotional well-being and emotional health as part of the considerations for patients [with psoriasis], but there are other differences in quality of life. What are some of those differences in quality of life that you see with your patients, and how are they impacting them on a day-to-day basis?

Amy McMichael, MD: If patients have very severe psoriasis—we talked about the thickening of the actual lesions, which tend to be a little more aggressive in patients of color—on their palms and feet, then that makes it impossible to walk and do anything with their hands. That’s 1 of the real indications that we need to go to a systemic medication and get you on it immediately, so that you can perform and give back to your community, do what you need to do at home. Location and thickness certainly make a difference in terms of quality of life.

Scalp involvement, which is so visible when it comes down onto the facial area, is much more common in patients of color, particularly with hypopigmentation and scaling. That has to be addressed more aggressively. Patients of color, especially women, often don’t wash their hair every day, so giving them an antidander shampoo and telling them to use it daily is going to be met with a significant amount of frustration. You have to understand the cultural background of that patient. How many times a week can you wash your hair? Let me give you something that you leave in the hair, leave on the scalp, so you can treat this disease. Even if we’re treating it systemically, sometimes we need to treat it topically to help with scale removal and anti-inflammatory treatment. Those are 2 of the bigger areas. We’ve touched on the other 1, which is the pigmentation or the dyschromia that psoriasis itself leaves. That can be very emotionally draining for patients, to deal with all this pigment even after the disease has improved.

Ryan Haumschild, PharmD, MS, MBA: You talked about psoriasis on the hands and feet. Many of us on a day-to-day basis utilize our extremities to do work, to stay active, to engage with our family members. But when I think about an employer, if we have patients with psoriasis, I want them to be high functioning, to pursue their passions and work, and to be productive employees of our organization. That’s what the employees a lot of times want. Unfortunately, when you’re living with psoriasis, that can’t always be the case. There might be some absenteeism that occurs with some patients.

I’ll turn to Dr Lopes as 1 of our managed care experts. When you think about some of these other costs associated with the disease, what are some of the costs and burdens that you think about associated with absenteeism and presenteeism that might relate to a patient with psoriasis?

Maria Lopes, MD, MS: That falls under the indirect costs. The data are critical. When there are absent data, we don’t know. In a peer-reviewed journal, the Journal of American Academy of Dermatology, this question was attempted in 2015. [A study] looked at health care resource utilization around different levels of severity for psoriasis, trying to quantify the impact on indirect costs. One of the findings from the study was that it correlates with a level of severity. Particularly for patients with moderate to severe psoriasis, the number of missed workdays increased. The percentage of patients no longer able to carry on full-time functions increased. Overall, a quarter of patients reported some level of work impairment.

It’s difficult to get your arms around how big the problem is. A lot of this can be self-reported, but it definitely has an impact. When you think about what this leads to, whether it’s depression, anxiety, or function, or other comorbidities, there’s an impact on workforce productivity, lost time from work, and psychosocial balance on these patients are functioning.

Ryan Haumschild, PharmD, MS, MBA: I appreciate you providing context to those indirect costs. That’s essential.

Transcript edited for clarity.

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