Medical School, University of Dundee, Dundee, Scotland.
National Managed Clinical Network for Phototherapy (Photonet), NHS Scotland, Dundee, UK.
Photodermatol Photoimmunol Photomed. 2020 Mar;36(2):90-96. doi: 10.1111/phpp.12511. Epub 2019 Oct 18.
Although used for decades in psoriasis, access to phototherapy is becoming increasingly restricted. Besides patient inconvenience, this is in large part to do with a perception of "high cost." We previously reported a comprehensive analysis of direct and indirect phototherapy treatment cost. However, no robust data exist on the actual savings associated with providing phototherapy in the treatment pathway.
To quantify the cost savings achieved by phototherapy by delaying alternative treatments.
Costs accruing through the UK-wide established treatment pathway with and without phototherapy were analysed. Direct and indirectly incurred drug treatment costs were calculated using drug tariff, laboratory cost, estate rates and clinic review costs. To enhance reliability, ranges of cost scenarios were calculated by varying parameters such as drug dosing.
Medium annual cost savings per patient were £2200 [range: £1800-£2900] for NB-UVB, and £3700 [range: £2500-£5300] if both NB-UVB and PUVA courses were administered, respectively. As the provider treated 656 ± 76 patients per year during the 6-year observational window, this amounted to savings of £Mio 2.4 [range: £Mio 1.6-£Mio 3.4], even excluding additional non-modelled drug-associated costs (eg diagnostics, adverse event management). Since we only consider cost savings by delay of drug treatment for the duration of phototherapy, drug price reductions through biosimilar introduction only have a small effect. We provide spreadsheets allowing adaptation cost savings projections by varying input variables.
Healthcare providers may achieve significant cost savings by implementing and/or widening access to phototherapy.
尽管光疗在银屑病治疗中已应用数十年，但现在其应用却受到了越来越多的限制。这在很大程度上是因为人们认为光疗“成本高”，除了给患者带来不便外。我们之前曾报告过一项关于光疗直接和间接治疗成本的综合分析。然而，在治疗途径中提供光疗所带来的实际节省方面，尚无确凿数据。
通过延迟替代疗法来量化光疗带来的成本节约。
分析有和没有光疗的英国广泛既定治疗途径中的成本。使用药物关税、实验室成本、房地产税率和诊所审查成本计算直接和间接产生的药物治疗成本。为了提高可靠性，通过改变药物剂量等参数计算成本情景的范围。
中值每年每位患者的节省额分别为窄谱中波紫外线（NB-UVB）治疗为 2200 英镑（范围：1800-2900 英镑），NB-UVB 和补骨脂素联合长波紫外线（PUVA）治疗分别为 3700 英镑（范围：2500-5300 英镑）。由于在 6 年观察期内，提供者每年治疗 656 ± 76 名患者，因此节省了 2400 万英镑（范围：1600 万至 3400 万英镑），即使不包括额外的未建模药物相关成本（例如诊断、不良反应管理）。由于我们仅考虑在光疗期间延迟药物治疗带来的成本节省，因此通过生物类似药引入降低药物价格的影响较小。我们提供了电子表格，可通过改变输入变量来调整成本节省预测。
医疗保健提供者通过实施和/或扩大光疗的应用范围，可以实现显著的成本节约。
