University of Dundee, Medical School, Dundee, U.K.
Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K.
Br J Dermatol. 2018 Nov;179(5):1148-1156. doi: 10.1111/bjd.16716. Epub 2018 Jul 29.
Narrowband ultraviolet B (NB-UVB) treatment for psoriasis is considered expensive. However, existing data are based on estimates and do not consider indirect cost savings.
To define the actual costs of NB-UVB incurred by the service provider, as well as treatment-associated cost savings.
We performed data linkage of (i) comprehensive treatment records and (ii) prescribing data for all NB-UVB treatment episodes spanning 6 years in a population of 420 000. We minimized data fluctuation by compiling data from four independent treatment sites, and using drug prescriptions unrelated to psoriasis as a negative control.
National Health Service Tayside spent an average of £257 per NB-UVB treatment course (mean 257 ± 63, range 150-286, across four independent treatment sites), contrasting sharply with the estimate of £1882 used by the U.K. National Institute for Health and Care Excellence. The cost of topical treatments averaged £128 per patient in the 12 months prior to NB-UVB, accounting for 42% of the overall drug costs incurred by these patients. This was reduced by 40% to £53 per patient over the 12-month period following NB-UVB treatment, while psoriasis-unrelated drug prescription remained unchanged, suggesting disease-specific effects of NB-UVB. The data were not due to site-specific factors, as confirmed by highly similar results observed between treatment sites operated by distinct staff. Finally, we detail all staff hours directly and indirectly involved in treatment, allowing direct translation of cost into other healthcare systems.
NB-UVB is a low-cost treatment; cost figures currently used in health technology appraisals are an overestimate based on the data presented here. Creating or extending access to NB-UVB is likely to offer additional savings by delaying or avoiding costly third-line treatments for many patients.
窄谱中波紫外线（NB-UVB）治疗银屑病被认为费用较高。然而，现有数据基于估算，并未考虑间接成本节约。
确定服务提供商实际承担的 NB-UVB 治疗费用，以及与治疗相关的成本节约。
我们对 42 万人群中 6 年内所有 NB-UVB 治疗疗程的（i）全面治疗记录和（ii）处方数据进行了数据链接。我们通过编译来自四个独立治疗地点的数据，并将与银屑病无关的药物处方作为阴性对照，以最小化数据波动。
泰赛德国民保健服务花费了平均每个 NB-UVB 疗程 257 英镑（四个独立治疗地点的平均值为 257 ± 63，范围 150-286），与英国国家卫生与保健优化研究所使用的 1882 英镑的估计值形成鲜明对比。在接受 NB-UVB 治疗前的 12 个月中，每位患者的外用药物治疗费用平均为 128 英镑，占这些患者总药物费用的 42%。在接受 NB-UVB 治疗后的 12 个月中，这一费用降低至每位患者 53 英镑，而与银屑病无关的药物处方保持不变，表明 NB-UVB 具有特定的疾病效应。这些数据并非特定于治疗地点的因素所致，因为不同工作人员运营的治疗地点之间观察到的结果非常相似，这一点得到了证实。最后，我们详细列出了直接和间接参与治疗的所有工作人员时间，允许将成本直接转化为其他医疗保健系统。
NB-UVB 是一种低成本的治疗方法；根据本文提供的数据，目前在卫生技术评估中使用的成本数据过高。为许多患者创造或扩大 NB-UVB 的使用机会，可能会通过延迟或避免昂贵的三线治疗来节省更多成本。
