Skip to main content
Top
Published in: BMC Dermatology 1/2018

Open Access 01-12-2018 | Research article

Real-world health outcomes in adults with moderate-to-severe psoriasis in the United States: a population study using electronic health records to examine patient-perceived treatment effectiveness, medication use, and healthcare resource utilization

Authors: April W. Armstrong, Shonda A. Foster, Brian S. Comer, Chen-Yen Lin, William Malatestinic, Russel Burge, Orin Goldblum

Published in: BMC Dermatology | Issue 1/2018

Login to get access

Abstract

Background

Little is known regarding real-world health outcomes data among US psoriasis patients, but electronic health records (EHR) that collect structured data at point-of-care may provide opportunities to investigate real-world health outcomes among psoriasis patients. Our objective was to investigate patient-perceived treatment effectiveness, patterns of medication use (duration, switching, and/or discontinuation), healthcare resource utilization, and medication costs using real-world data from psoriasis patients.

Methods

Data for adults (≥18-years) with a dermatology provider-given diagnosis of psoriasis from 9/2014–9/2015 were obtained from dermatology practices using a widely used US dermatology-specific EHR containing over 500,000 psoriasis patients. Disease severity was captured by static physician’s global assessment and body surface area. Patient-perceived treatment effectiveness was assessed by a pre-defined question. Treatment switching and duration were documented. Reasons for discontinuations were assessed using pre-defined selections. Healthcare resource utilization was defined by visit frequency and complexity.

Results

From 82,621 patients with psoriasis during the study period, patient-perceived treatment effectiveness was investigated in 2200 patients. The proportion of patients reporting “strongly agree” when asked if their treatment was effective was highest for biologics (73%) and those reporting treatment adherence (55%). In 16,000 patients who received oral systemics and 21,087 patients who received biologics, median treatment duration was longer for those who received biologics (160 vs. 113 days, respectively). Treatment switching was less frequent among patients on systemic monotherapies compared to those on combination therapies. The most common reason for discontinuing biologics was loss of efficacy; the most common reason for discontinuing orals was side effects. In 28,754 patients, higher disease severity was associated with increased healthcare resource utilization (increased visit frequency and complexity). When compared between treatment groups (n = 10,454), healthcare resource utilization was highest for phototherapy. Annual medication costs were higher for biologics ($21,977) than oral systemics ($3413).

Conclusions

Real-world research using a widely implemented dermatology EHR provided valuable insights on patient perceived treatment effectiveness, patterns of medication usage, healthcare resource utilization, and medication costs for psoriasis patients in the US. This study and others utilizing EHRs for real-world research may assist clinical and payer decisions regarding the management of psoriasis.
Appendix
Available only for authorised users
Literature
2.
go back to reference Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70(3):512–6.CrossRefPubMed Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70(3):512–6.CrossRefPubMed
3.
go back to reference Vanderpuye-Orgle J, Zhao Y, Lu J, Shrestha A, Sexton A, Seabury S, Lebwohl M. Evaluating the economic burden of psoriasis in the United States. J Am Acad Dermatol. 2015;72:961–7. e965CrossRefPubMed Vanderpuye-Orgle J, Zhao Y, Lu J, Shrestha A, Sexton A, Seabury S, Lebwohl M. Evaluating the economic burden of psoriasis in the United States. J Am Acad Dermatol. 2015;72:961–7. e965CrossRefPubMed
4.
go back to reference Edson-Heredia E, Zhu B, Lefevre C, Wang M, Barrett A, Bushe CJ, Cox A, Wu JJ, Maeda-Chubachi T. Prevalence and incidence rates of cardiovascular, autoimmune, and other diseases in patients with psoriatic or psoriatic arthritis: a retrospective study using clinical practice research datalink. J Eur Acad Dermatol Venereol. 2015;29:955–63.CrossRefPubMed Edson-Heredia E, Zhu B, Lefevre C, Wang M, Barrett A, Bushe CJ, Cox A, Wu JJ, Maeda-Chubachi T. Prevalence and incidence rates of cardiovascular, autoimmune, and other diseases in patients with psoriatic or psoriatic arthritis: a retrospective study using clinical practice research datalink. J Eur Acad Dermatol Venereol. 2015;29:955–63.CrossRefPubMed
5.
go back to reference Famenini S, Sako EY, Wu JJ. Effect of treating psoriasis on cardiovascular co-morbidities: focus on TNF inhibitors. Am J Clin Dermatol. 2014;15:45–50.CrossRefPubMed Famenini S, Sako EY, Wu JJ. Effect of treating psoriasis on cardiovascular co-morbidities: focus on TNF inhibitors. Am J Clin Dermatol. 2014;15:45–50.CrossRefPubMed
6.
go back to reference Fried RG, Friedman S, Paradis C, Hatch M, Lynfield Y, Duncanson C, Shalita A. Trivial or terrible? The psychosocial impact of psoriasis. Int J Dermatol. 1995;34:101–5.CrossRefPubMed Fried RG, Friedman S, Paradis C, Hatch M, Lynfield Y, Duncanson C, Shalita A. Trivial or terrible? The psychosocial impact of psoriasis. Int J Dermatol. 1995;34:101–5.CrossRefPubMed
7.
go back to reference Nguyen T, Wu JJ. Relationship between tumor necrosis factor-α inhibitors and cardiovascular disease in psoriasis: a review. Permanente J. 2014;18:49–54.CrossRef Nguyen T, Wu JJ. Relationship between tumor necrosis factor-α inhibitors and cardiovascular disease in psoriasis: a review. Permanente J. 2014;18:49–54.CrossRef
8.
go back to reference Sommer DM, Jenisch S, Suchan M, Christophers E, Weichenthal M. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res. 2006;298:321–8.CrossRefPubMed Sommer DM, Jenisch S, Suchan M, Christophers E, Weichenthal M. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res. 2006;298:321–8.CrossRefPubMed
9.
go back to reference Wu JJ, Choi YM, Bebchuk JD. Risk of myocardial infarction in psoriasis patients: a retrospective cohort study. J Dermatolog Treat. 2015;26:230–4.CrossRefPubMed Wu JJ, Choi YM, Bebchuk JD. Risk of myocardial infarction in psoriasis patients: a retrospective cohort study. J Dermatolog Treat. 2015;26:230–4.CrossRefPubMed
10.
go back to reference Wu JJ, Nguyen TU, Poon K-YT, Herrinton LJ. The association of psoriasis with autoimmune diseases. J Am Acad Dermatol. 2012;67:924–30.CrossRefPubMed Wu JJ, Nguyen TU, Poon K-YT, Herrinton LJ. The association of psoriasis with autoimmune diseases. J Am Acad Dermatol. 2012;67:924–30.CrossRefPubMed
11.
go back to reference Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999;41(3 Pt 1):401–7.CrossRefPubMed Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999;41(3 Pt 1):401–7.CrossRefPubMed
12.
go back to reference Armstrong AW, Reddy SB, Garg A. Novel approach to utilizing electronic health records for dermatologic research: developing a multi-institutional federated data network for clinical and translational research in psoriasis and psoriatic arthritis. Dermatol Online J. 2012;18(5):2. Armstrong AW, Reddy SB, Garg A. Novel approach to utilizing electronic health records for dermatologic research: developing a multi-institutional federated data network for clinical and translational research in psoriasis and psoriatic arthritis. Dermatol Online J. 2012;18(5):2.
13.
go back to reference Davison NJ, Warren RB, Mason KJ, McElhone K, Kirby B, Burden AD, Smith CH, Payne K, Griffiths CEM. Identification of factors that may influence the selection of first-line biological therapy for people with psoriasis: a prospective, multicentre cohort study. Br J Dermatol. 2017;177(3):828–36.CrossRefPubMed Davison NJ, Warren RB, Mason KJ, McElhone K, Kirby B, Burden AD, Smith CH, Payne K, Griffiths CEM. Identification of factors that may influence the selection of first-line biological therapy for people with psoriasis: a prospective, multicentre cohort study. Br J Dermatol. 2017;177(3):828–36.CrossRefPubMed
14.
go back to reference Iskandar IY, Ashcroft DM, Warren RB, Yiu ZZ, McElhone K, Lunt M, Barker JN, Burden AD, Ormerod AD, Reynolds NJ, et al. Demographics and disease characteristics of patients with psoriasis enrolled in the British Association of Dermatologists biologic interventions register. Br J Dermatol. 2015;173(2):510–8.CrossRefPubMed Iskandar IY, Ashcroft DM, Warren RB, Yiu ZZ, McElhone K, Lunt M, Barker JN, Burden AD, Ormerod AD, Reynolds NJ, et al. Demographics and disease characteristics of patients with psoriasis enrolled in the British Association of Dermatologists biologic interventions register. Br J Dermatol. 2015;173(2):510–8.CrossRefPubMed
15.
go back to reference Iskandar IYK, Ashcroft DM, Warren RB, Evans I, McElhone K, Owen CM, Burden AD, Smith CH, Reynolds NJ, Griffiths CEM. Patterns of biologic therapy use in the management of psoriasis: cohort study from the British Association of Dermatologists biologic interventions register (BADBIR). Br J Dermatol. 2017;176(5):1297–307.CrossRefPubMed Iskandar IYK, Ashcroft DM, Warren RB, Evans I, McElhone K, Owen CM, Burden AD, Smith CH, Reynolds NJ, Griffiths CEM. Patterns of biologic therapy use in the management of psoriasis: cohort study from the British Association of Dermatologists biologic interventions register (BADBIR). Br J Dermatol. 2017;176(5):1297–307.CrossRefPubMed
16.
go back to reference Burden AD, Warren RB, Kleyn CE, McElhone K, Smith CH, Reynolds NJ, Ormerod AD, Griffiths CE. The British Association of Dermatologists’ biologic interventions register (BADBIR): design, methodology and objectives. Br J Dermatol. 2012;166(3):545–54.CrossRefPubMed Burden AD, Warren RB, Kleyn CE, McElhone K, Smith CH, Reynolds NJ, Ormerod AD, Griffiths CE. The British Association of Dermatologists’ biologic interventions register (BADBIR): design, methodology and objectives. Br J Dermatol. 2012;166(3):545–54.CrossRefPubMed
17.
go back to reference Ihaka R, Gentleman R. R: a language for data analysis and graphics. J Comput Graph Stat. 1996;5(3):299–314. Ihaka R, Gentleman R. R: a language for data analysis and graphics. J Comput Graph Stat. 1996;5(3):299–314.
18.
go back to reference Lebwohl MG, Kavanaugh A, Armstrong AW, Van Voorhees AS. US perspectives in the Management of Psoriasis and Psoriatic Arthritis: patient and physician results from the population-based multinational assessment of psoriasis and psoriatic arthritis (MAPP) survey. Am J Clin Dermatol. 2016;17(1):87–97.CrossRefPubMed Lebwohl MG, Kavanaugh A, Armstrong AW, Van Voorhees AS. US perspectives in the Management of Psoriasis and Psoriatic Arthritis: patient and physician results from the population-based multinational assessment of psoriasis and psoriatic arthritis (MAPP) survey. Am J Clin Dermatol. 2016;17(1):87–97.CrossRefPubMed
19.
go back to reference Armstrong AW, Robertson AD, Wu J, Schupp C, Lebwohl MG. Undertreatment, treatment trends, and treatment dissatisfaction among patients with psoriasis and psoriatic arthritis in the United States: findings from the National Psoriasis Foundation surveys, 2003-2011. JAMA Dermatol. 2013;149(10):1180–5.CrossRefPubMed Armstrong AW, Robertson AD, Wu J, Schupp C, Lebwohl MG. Undertreatment, treatment trends, and treatment dissatisfaction among patients with psoriasis and psoriatic arthritis in the United States: findings from the National Psoriasis Foundation surveys, 2003-2011. JAMA Dermatol. 2013;149(10):1180–5.CrossRefPubMed
20.
go back to reference Levin AA, Gottlieb AB, Au SC. A comparison of psoriasis drug failure rates and reasons for discontinuation in biologics vs conventional systemic therapies. J Drugs Dermatol. 2014;13(7):848–53.PubMed Levin AA, Gottlieb AB, Au SC. A comparison of psoriasis drug failure rates and reasons for discontinuation in biologics vs conventional systemic therapies. J Drugs Dermatol. 2014;13(7):848–53.PubMed
21.
go back to reference Evans C. Managed care aspects of psoriasis and psoriatic arthritis. Am J Manag Care. 2016;22(8 Suppl):s238–43.PubMed Evans C. Managed care aspects of psoriasis and psoriatic arthritis. Am J Manag Care. 2016;22(8 Suppl):s238–43.PubMed
22.
go back to reference Papoutsaki M, Costanzo A. Treatment of psoriasis and psoriatic arthritis. BioDrugs. 2013;27(Suppl 1):3–12.CrossRefPubMed Papoutsaki M, Costanzo A. Treatment of psoriasis and psoriatic arthritis. BioDrugs. 2013;27(Suppl 1):3–12.CrossRefPubMed
23.
go back to reference Besen J, McDermott L, Lam C, Legler A, Burris K, Garg A. Validation and comparison of psoriasis case-finding algorithms using international classification of diseases nosology. J Psoriasis Psoriatic Arthritis. 2016;1(3):123–7. Besen J, McDermott L, Lam C, Legler A, Burris K, Garg A. Validation and comparison of psoriasis case-finding algorithms using international classification of diseases nosology. J Psoriasis Psoriatic Arthritis. 2016;1(3):123–7.
Metadata
Title
Real-world health outcomes in adults with moderate-to-severe psoriasis in the United States: a population study using electronic health records to examine patient-perceived treatment effectiveness, medication use, and healthcare resource utilization
Authors
April W. Armstrong
Shonda A. Foster
Brian S. Comer
Chen-Yen Lin
William Malatestinic
Russel Burge
Orin Goldblum
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Dermatology / Issue 1/2018
Electronic ISSN: 1471-5945
DOI
https://doi.org/10.1186/s12895-018-0072-2

Other articles of this Issue 1/2018

BMC Dermatology 1/2018 Go to the issue