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Healthcare Pathways and Burden of Disease of Patients With Psoriasis and Psoriatic Arthritis

      Objectives

      Psoriasis and Psoriatic Arthritis (PsA) are chronic, inflammatory, autoimmune diseases that negatively impact on health-related quality of life. The aim of this study was to analyze the healthcare profile and the overall cost of patients with Psoriasis/PsA in the real clinical practice.

      Methods

      From ARNO Observatory database we carried out a record linkage analysis of disease exemptions, drug prescriptions and specialist services on 2.988.195 subjects, with available, complete and good quality data. Patients with Psoriasis/PsA were collected from 01/01/2009 to 31/12/2011 (accrual period) and followed up to 2 years, to analyze specific treatments (DMARDs, biological, topical), therapy switches, community and hospital cares and their expenditure (mean/patient).

      Results

      Of 2.988.195 subjects, 6.030 met two or more inclusion criteria (53% men, mean age 54,5±14,6 years). During the 2-year follow-up non-biological and biological drugs were prescribed respectively to 2.738 (45%) and to 902 (15%) patients. 591 took both: 390 (66%) started DMARDs then switched to biological treatments in 7±6 months on average. 2.783 (46%) patients received “other drugs”, mostly NSAIDs, Corticosteroids (systemic and dermatological use), Penicillins and Quinolone antibacterials. 950 patients (16%) were discharged from ordinary and daily hospitalizations mainly for skin, connective tissue and cardiovascular (CVD) diseases. CVD and Neoplasia (8195€/patient/2-year follow-up) were between the most expensive causes of ordinary admissions. Psychiatric disorders caused the longest stay in-hospital (33,5 mean days/patient). 51,5% of patients received specialist healthcare services (blood count and liver enzymes). Patients treated with biological drugs were more expensive than those treated with DMARDs and topical therapies, for pharmaceutical, in-hospital and specialist cares (7.978€/patient/year of follow-up).

      Conclusions

      This assessment of healthcare profiles of patients with Psoriasis/PsA in the real in-hospital and community Italian settings provided evidence that patients treated with biological therapies are those with a more compromised health that induces high costs on all aspects of their care.