Photobiology Unit, The Department of Dermatology, Level 8, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
Photobiology Unit, The Department of Dermatology, Level 8, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
Public Health. 2014 Apr;128(4):317-24. doi: 10.1016/j.puhe.2014.01.011. Epub 2014 Apr 13.
To review the Tayside home phototherapy service, including numbers of patients treated, diagnoses and outcomes, side-effects and safety, cost-effectiveness and absolute costs. To consider why home or outpatient phototherapy is not available to all patients who might benefit and how this could be addressed.
Observational and cost analysis.
Analysis of the Tayside home phototherapy database 1998 and 2011, home phototherapy patient questionnaires, outcome data, costs and a comparison with outpatient phototherapy. Review of literature and current national guidelines for phototherapy, traditional systemic and biologic therapies for psoriasis.
298 courses of home narrowband UVB (NB-UVB) phototherapy were undertaken by 212 patients between 1998 and 2011, five courses in 1998 increasing to 36 in 2011. The main diagnoses treated were psoriasis (72%), atopic dermatitis (8%), and desensitization of photodermatosis (7%). For psoriasis, 74.5% achieved clearance or minimal residual activity in a median of 30 exposures (range 10-60). The estimated costs to the hospital ranged from £229 to £314 per course (£307 to £422 per effective course for psoriasis), compared with £114 for out-patient therapy (£149 per effective course for psoriasis). The total cost to society (hospital and patient costs) is around £410 per course, compared to an estimated £550 for outpatient therapy for this group of patients. Treatment was well tolerated, erythema rates were similar to outpatient therapy, there were no complaints and the vast majority would choose home over outpatient phototherapy if required in the future.
Hospital supervised home phototherapy appears as safe and effective as outpatient therapy and provides equality of access for patients who cannot attend for outpatient therapy. These patients may otherwise be inadequately treated or given more costly and higher risk systemic therapies, particularly for psoriasis. Commissioners and clinicians involved in dermatology services should provide accessible phototherapy for all patients who might benefit, utilizing home phototherapy where outpatient access is not possible.
回顾泰赛德家庭光疗服务，包括治疗的患者数量、诊断和结果、副作用和安全性、成本效益和绝对成本。考虑为什么不是所有可能受益的患者都能接受家庭或门诊光疗，以及如何解决这个问题。
观察性和成本分析。
分析 1998 年和 2011 年泰赛德家庭光疗数据库、家庭光疗患者问卷、结果数据、成本，并与门诊光疗进行比较。回顾光疗、银屑病的传统全身和生物疗法的文献和当前国家指南。
1998 年至 2011 年间，212 名患者共接受了 298 次家庭窄谱 UVB（NB-UVB）光疗，1998 年 5 次，2011 年 36 次。主要治疗诊断为银屑病（72%）、特应性皮炎（8%）和光皮病脱敏（7%）。对于银屑病，中位数 30 次照射（范围 10-60 次）后 74.5%达到清除或最小残留活动。医院的估计成本为每次疗程 229 英镑至 314 英镑（银屑病每次有效疗程 307 英镑至 422 英镑），而门诊治疗为 114 英镑（银屑病每次有效疗程 149 英镑）。该组患者的社会总成本（医院和患者成本）约为每次疗程 410 英镑，而门诊治疗估计为 550 英镑。治疗耐受性良好，红斑发生率与门诊治疗相似，无投诉，绝大多数患者如果将来需要，宁愿选择家庭治疗而不是门诊治疗。
医院监督的家庭光疗与门诊治疗一样安全有效，为不能进行门诊治疗的患者提供了平等的治疗机会。否则，这些患者可能得不到充分治疗，或者接受更昂贵和风险更高的全身治疗，尤其是对于银屑病。参与皮肤科服务的管理者和临床医生应为所有可能受益的患者提供可及的光疗，在无法进行门诊治疗的情况下，利用家庭光疗。
