Managed Care - January 2009 - (Page CB-A4)

In 2007, 79 percent of NPF survey respondents indicated that psoriasis posed a moderate or large problem in their everyday lives (Figure Large Moderate Small 50 3). The percentage is quite similar 46 44 to the results of the previously 45 42 41 noted spring 2004 survey, when 83 39 40 38 percent reported that psoriasis pre34 35 33 sented a moderate or large problem 30 (NPF 2004). Additional indications 25 that patients with psoriasis experi25 21 ence problems in their daily lives 19 20 17 are seen in the high percentages of 15 NPF survey respondents who con10 sistently point to strong feelings of 5 anger or self-consciousness, or who conceal their psoriasis with cloth0 2004 2005 2006 2007 ing (Table). (N=594) (N=418) (N=389) (N=396) Among those with severe psoriasis, patients also report issues Respondents were asked to indicate, on a scale of 1 to 10, whether psoriasis with receiving equal treatment in a presented a small, moderate, or large problem in their everyday life (1=no problem, 10=very large problem). In this figure, “small” includes responses from 1 to 3; variety of service establishments, “moderate,” 4 to 7; and “large,” 8 to 10. The percentages depicted are from surveys including hair salons or barberconducted in the spring of the years indicated. shops (24 percent), public pools (19 percent), and health clubs (11 Sources: Adapted from NPF 2004, 2005, 2006, and 2007. percent) (Krueger 2001). This treatment prior to age 40 had a risk of cardiovascular study featured a four-page, self-administered questiondeath that was 2.6-fold that of the general public, and naire that was mailed to the entire membership of the among those patients with three or more hospitalizations, NPF (N=40,350), with a response rate of 43 percent. the risk of cardiovascular death was about 3 times that Patients with severe psoriasis were then surveyed via seen in patients hospitalized only once (Mallbris 2004). telephone. Another study found that among a group of In addition, patients with severe psoriasis appear to 137 inpatients with moderate to severe psoriasis, 26 perhave a higher risk of death compared to patients without cent reported that during the last month they had expepsoriasis. Researchers conducted a retrospective cohort rienced an occasion when “people made a conscious study using a medical records database in the United Kingeffort not to touch them” (Gupta 1998). dom. Compared with patients without psoriasis, male A large percentage of respondents to NPF surveys patients with severe psoriasis died an average of 3.5 years have reported other negative psychosocial effects of psoearlier, and female patients with severe psoriasis died 4.4 riasis on their everyday lives, such as problems with years earlier (Gelfand 2007). sleeping (48 percent), interference with sexual activities (29 percent), and problems using their hands (36 perDiminished quality of life cent) (NPF 2008). Of particular concern is the almost 10 Various needs of psoriasis patients may remain unmet. percent of patients who wished to be dead, as reported in a study of 217 patients (both inpatients and outpatients) with psoriasis TABLE (Gupta 1993). Quality of life factors in psoriasis Contemplation of suicide also has Percentage of psoriasis patients who report: been shown to differ according to a 2005 2006 2007 patient’s age (Krueger 2001). For patients between the ages of 18 and Anger and frustration, strong feelings of 44 48 44 34, there is a 10 percent prevalence of Self-consciousness, strong feelings of 45 38 40 contemplation; that figure drops to 7 Having to choose clothing to conceal psoriasis 47 46 40 percent for those between 35 and 54, Sources: NPF 2005, 2006, and 2007. and to 3 percent for those patients 55 and older. FIGURE 3 Extent to which psoriasis is a problem in patients’ everyday lives 4

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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