Healthcare resource use of patients with mild-moderate psoriasis on systemic treatments: a UK single-center longitudinal retrospective cohort study

Healthcare resource utilization (HCRU) costs in those on conventional systemics for mild-moderate psoriasis are poorly described. This study aimed to describe HRCU, disease severity and health-related quality of life in patients with mild-moderate psoriasis requiring systemic therapy. UK single-center retrospective longitudinal cohort study including adults with mild-moderate psoriasis (PASI < 10, no historical PASI ≥ 10, no prior biologics) on conventional systemic therapy with 3-year data capture from first PASI recording (2014–2019, pre-COVID). Patients discontinued due to reaching PASI ≥ 10, starting biologics or being lost to follow-up. The median annual HCRU cost was £1923 (mean £3361), largely driven by visit costs. A total of 50.8% patients achieved a PASI ≤ 2 and 30.6% achieved PASI ≤ 2 and DLQI ≤ 5 during follow-up. The difference between the maximum and minimum PASI for a patient and follow-up time were statistically significant predictors of total costs (p < 0.05). Despite high healthcare costs, nearly half of the patients did not achieve clear/nearly clear skin. These data, in the context of reducing costs for biosimilars, may provide a basis to challenge care pathways and access criteria for ‘high-cost’ treatments. Psoriasis is a common chronic skin condition, but the costs of treatment and care for the mild-to-moderate patient group are not well understood. Most studies focus on severe psoriasis treated with high-cost biologic drugs, but the majority of patients do not meet the access criteria for these therapies. The authors aimed to explore the healthcare costs and progress (including psoriasis severity and impact on quality of life) in patients with mild-to-moderate psoriasis receiving systemic (tablet) treatments. Data were collected from the electronic healthcare records of 124 adults with mild-to-moderate psoriasis treated at one healthcare center from 2014 to 2019. These patients had mild-moderate psoriasis, had never had severe psoriasis and had never received biologic treatments. The information collected included patient characteristics, healthcare visits, treatments, psoriasis severity and skin-related quality of life for up to three years. The authors found that the average annual healthcare costs per patient were £3,361 (€3,863), mostly attributable to healthcare visits. However, despite ongoing treatment, nearly half of the patient group did not achieve the optimal treatment target of clear or nearly clear skin. It was noted that patients whose psoriasis severity fluctuated had higher costs, suggesting that unstable disease is linked to higher healthcare costs. This study has shown that managing mild-to-moderate psoriasis with standard systemic treatment can be expensive, often without achieving optimal results. Understanding the cost of treatment and patient experience in this group is important to facilitate the ongoing review and appropriateness of access criteria for more advanced therapies.