Souliotis Kyriakos, Golna Christina, Kani Chara, Litsa Panagiota
a University of Peloponnese , Faculty of Social and Political Sciences , Conrith , Greece.
b Policy Consultant , Maroussi , Athens , Greece.
J Med Econ. 2016 Nov;19(11):1021-1026. doi: 10.1080/13696998.2016.1192547. Epub 2016 Jun 3.
Psoriasis is a chronic inflammatory skin disease that requires treatment to manage co-morbidities and improve patient quality-of-life. This study estimated the budget impact to National Organization for Health Care Services Provision (EOPYY) of changing reimbursement of psoriasis treatment with topical and systemic, non-biologic, agents (75%) to bring it on par with that of biologic agents (100%) in Greece.
The Business Intelligence database of EOPYY was used to identify and provide analytics on patients with plaque psoriasis. Permission for use of anonymized data was obtained by the administration of EOPYY. EOPYY is responsible for funding healthcare and pharmaceutical care services for ∼95% of the permanent population in the country. Pre-defined ICD-10 codes were applied to identify patients with plaque psoriasis and at least one reimbursed prescription between 1 June 2014 and 31 May 2015. Age, gender, medications, and cost were recorded for these patients.
Of the 45,581 unique patients identified through completely anonymized data on the e-prescription system, 72% were on treatment with topicals only and accounted for 5% of EOPYY psoriasis expenditure. Another 9% of patients were on methotrexate or a per os (POS, orally administered) systemic agent and accounted for 2.35% of total expenditure. Approximately 12% of total patients were on treatment with a biologic-containing regimen and accounted for almost 90% of psoriasis expenditure. Patients on biologics were younger than patients on topical and systemic treatments. The burden to EOPYY of adjusting reimbursement levels for topical and systemic, non-biologic, treatments to 100% of their cost was estimated at €2.05 per patient per month for topical treatments (monotherapy) and an additional €9.5 per patient per month for treatment with methotrexate, POS systemic agents, and their combinations with topical agents. This additional cost is expected to be offset by averting 200 earlier than clinically necessary switches from topical and systemic, non-biologic, treatments to expensive biologics a year.
In circumstances of severe funding constraints for social health insurance in Greece, bringing patient copayment levels for psoriasis treatment on par with each other may aid proper clinical management of the condition, whilst achieving adequate treatment outcomes at optimal cost.
银屑病是一种慢性炎症性皮肤病，需要进行治疗以控制合并症并提高患者生活质量。本研究估计了希腊将银屑病局部和全身非生物制剂治疗的报销比例（75%）提高到与生物制剂报销比例（100%）相同水平后，对国家医疗服务提供组织（EOPYY）的预算影响。
使用EOPYY的商业智能数据库来识别和分析斑块状银屑病患者。EOPYY管理部门已获得使用匿名数据的许可。EOPYY负责为该国约95%的常住人口提供医疗保健和药品护理服务资金。应用预定义的国际疾病分类第十版（ICD - 10）编码来识别2014年6月1日至2015年5月31日期间患有斑块状银屑病且至少有一张报销处方的患者。记录这些患者的年龄、性别、用药情况和费用。
通过电子处方系统中完全匿名的数据识别出45,581名独特患者，其中72%仅接受局部治疗，占EOPYY银屑病支出的5%。另外9%的患者使用甲氨蝶呤或口服全身制剂，占总支出的2.35%。约12%的患者接受含生物制剂的治疗方案，几乎占银屑病支出的90%。使用生物制剂的患者比接受局部和全身治疗的患者年轻。将局部和全身非生物治疗的报销水平调整到其成本的100%，EOPYY为此承担的负担估计为：局部治疗（单一疗法）每位患者每月2.05欧元，使用甲氨蝶呤、口服全身制剂及其与局部制剂联合治疗的患者，每位患者每月额外增加9.5欧元。预计通过每年避免200例比临床必要时间更早地从局部和全身非生物治疗转向昂贵生物制剂的情况，可抵消这笔额外费用。
在希腊社会医疗保险资金严重紧张的情况下，使银屑病治疗的患者自付费用水平保持一致，可能有助于对该疾病进行适当的临床管理，同时以最佳成本实现充分的治疗效果。
