Managed Care - January 2009 - (Page CB-A2)

Unmet Needs in the Management of Plaque Psoriasis Because a curative therapy does not exist for psoriasis, patients with this condition seek improvements in quality of life and a reduction in the burdens of disease. Psychosocial components of psoriasis also should be considered when managing patients. A ccording to the National Psoriasis Foundation (NPF), a patient advocacy group, psoriasis is a chronic, immune-mediated disease that manifests itself in the skin of patients (NPF 2008). Its most common form, plaque psoriasis, presents as inflamed red lesions or patches of skin that are covered with a silvery white buildup of dead skin cells, known as scale (NPF 2008). Severity varies among individuals, and can range from only a few lesions to moderate or large areas of affected skin (Krueger 2000). It has been estimated that between 5.8 and 7.5 million Americans have been diagnosed with psoriasis (NPF 2008). What sets psoriasis apart from other chronic conditions is a strong psychosocial component (Figure 1), such that the degree of disease severity as perceived by the patient often does not correspond with the clinician’s severity assessment (Fortune 1998). None of the currently available therapies or combination of therapies offers a cure; thus, treatment is aimed at reducing the burden of disease and achieving an improvement in its signs and symptoms. The unmet needs of psoriasis patients are evident in the results of surveys conducted twice a year since 2003 by the NPF. Its members differ from the general psoriatic population in several important respects: they have more FIGURE 1 Psoriasis: impact on health-related quality of life extensive disease; they are better informed about treatment options; and they are more satisfied with those treatments (Nijsten 2005). However, describing NPF patients with psoriasis as “more satisfied” with their treatments is not the same as saying that they find those treatments satisfying. NPF’s spring 2007 survey reported highlights from interviews that were conducted with 403 patients with psoriasis and psoriatic arthritis by telephone (n=201) and online (n=202). Respondents were screened for a balance in gender, and more than 70 percent had moderate to severe psoriasis (not defined). Of the respondents, 29 percent said they were very satisfied with their treatment, which represents substantial improvement over the results of the spring 2004 survey, which found 15 percent of respondents with the same opinion (NPF 2007, NPF 2004). This 2004 survey interviewed 619 individuals with psoriasis and psoriatic arthritis by phone (n=200) and online (n=491), screened for balance of gender and age. Approximately 82 percent of respondents had moderate to severe psoriasis (not defined). At the same time, however, the spring 2007 survey also found that 10 percent of patients were not in treatment, either because they had “given up” or because of the cost of treatment (NPF 2007). Patient-reported short-form (SF)-36 scores, compared with other conditions. SF-36 scores range from 0 to 100. SF-36 physical component SF-36 mental component 53 46 41 49 43 45 49 42 45 35 50 45 35 52 47 46 44 43 52 42 52 60 50 40 30 20 10 0 55 Healthy adults Psoriasis Arthritis Cancer Chronic lung disease Congestive Depression Dermatitis heart failure Hypertension Myocardial infarction Type 2 diabetes Source: Adapted from Rapp 1999. 2

Table of Contents Feed for the Digital Edition of Managed Care - January 2009

Managed Care - January 2009 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Health Care's Disruptive Innovations Q&A With Clayton Christensen 'Disruption' May Be Plans' Best Bet Avoid the PBM Rebate Trap HealthPartners Puts Diabetes on Notice Formulary Files Plan Watch Tomorrow's Medicine Ad Index Outlook Unmet Needs in the Management of Plaque Psoriasis Impact of RSV: Implications for Managed Care

Managed Care - January 2009

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