Feldman Steven R, Goffe Bernard, Rice Gary, Mitchell Matthew, Kaur Mandeep, Robertson Debbie, Sierka Debra, Bourret Jeffrey A, Evans Tamara S, Gottlieb Alice
Professor of Dermatology, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC.
Dermatologist, Dermatology Associates, and Division of Dermatology, University of Washington, Seattle.
Am Health Drug Benefits. 2016 Dec;9(9):504-513.
Psoriasis is a debilitating chronic inflammatory autoimmune disease affecting approximately 7.4 million adults in the United States. Plaque psoriasis is the most common form, affecting 80% to 90% of patients.
To describe the impact and challenges that psoriasis presents for various stakeholders, and to provide nondermatologist healthcare decision makers with information to enhance their contributions to drug and pharmacy benefit design discussions.
Psoriasis carries an increased risk for early mortality and an increased prevalence of comorbidities, including psoriatic arthritis, cardiovascular disease, and diabetes. It is also associated with anxiety, depression, and social isolation, and can negatively impact patients' relationships, productivity, and careers. The physical, psychologic, social, and economic impact of psoriasis, plus the associated stigma, result in cumulative impairment over a patient's lifetime. The current treatments for moderate-to-severe psoriasis include topical therapy, phototherapy, and systemic drugs (nonbiologic and biologic); however, patient satisfaction remains low, combination therapy and treatment switching are common, and many patients remain untreated or undertreated. Clinicians should consider the patient holistically, and should select treatment based on a range of factors, including disease severity (with physical and psychosocial manifestations), susceptibility to cumulative life-course impairment (considering personality, behavior, and cognition), comorbidities, concomitant medication, and patient preference. It is estimated that the total annual direct cost of treating psoriasis in the United States in 2015 exceeded $12.2 billion.
Psoriasis is a complex disease, and appropriate management is correspondingly complex. Newer psoriasis treatments provide improved efficacy and safety versus traditional treatments, but challenges remain in ensuring patients access to these medications. An improved understanding of the barriers to appropriate treatment is needed, as well as clear and accessible information for payers and clinicians on current treatment options, to ensure that decision makers can control costs while providing patients with optimal care.
银屑病是一种使人衰弱的慢性炎症性自身免疫性疾病，在美国约有740万成年人受其影响。斑块状银屑病是最常见的形式，影响80%至90%的患者。
描述银屑病给不同利益相关者带来的影响和挑战，并为非皮肤科医疗保健决策者提供信息，以增强他们对药物和药房福利设计讨论的贡献。
银屑病会增加早期死亡风险以及合并症的患病率，包括银屑病关节炎、心血管疾病和糖尿病。它还与焦虑、抑郁和社交孤立有关，并会对患者的人际关系、生产力和职业产生负面影响。银屑病在身体、心理、社会和经济方面的影响，加上相关的污名化，会导致患者一生的累积损害。目前治疗中重度银屑病的方法包括局部治疗、光疗和全身用药（非生物制剂和生物制剂）；然而，患者满意度仍然较低，联合治疗和治疗转换很常见，许多患者仍未得到治疗或治疗不足。临床医生应全面考虑患者，并应根据一系列因素选择治疗方法，包括疾病严重程度（包括身体和心理社会表现）、对累积生命历程损害的易感性（考虑个性、行为和认知）、合并症、伴随用药情况以及患者偏好。据估计，2015年美国治疗银屑病的年度总直接成本超过122亿美元。
银屑病是一种复杂的疾病，相应地，其适当管理也很复杂。与传统治疗方法相比，新型银屑病治疗方法具有更高的疗效和安全性，但在确保患者能够获得这些药物方面仍存在挑战。需要更好地了解适当治疗的障碍，以及为支付方和临床医生提供关于当前治疗选择的清晰易懂的信息，以确保决策者在为患者提供最佳护理的同时能够控制成本。
