Managed Care - January 2009 - (Page CB-A5)

Managed Care Considerations Improving the Care of Patients with Psoriasis By Alexa B. Kimball, MD, MPH, Associate Professor, Harvard Medical School; and Vice Chair, Department of Dermatology, Director, Clinical Unit for Research Trials in Skin, Massachusetts General Hospital, Boston P soriasis is a chronic and discareer choices because of stigmatiabling illness (NIAMS 2003). zation, and it has a negative In my professional experiimpact on work productivity, job ence, patients with psoriasis are retention, and missed workdays expert at hiding their disease and (Schmitt 2006). their suffering, so the That brings us back to magnitude of their distherapy. I have a picture that tress often is overlooked. I took several years ago after We have made incredible asking one of my patients to progress in the underbring in the jumbled constanding and treatment tents of his medicine cabiof psoriasis over the past net. That photo is a decade, but I believe metaphor for what many of there are still real and my patients have experiAlexa B. Kimball, MD, MPH meaningful improveenced: that psoriasis therments needed to move apy is a miserable, timeforward in the care of this patient consuming, confusing, messy, and population. just unpleasant experience. More In the past 10 years, we have and more, however, I believe our gained not only a better undertraditional treatment paradigms are standing of the biology behind this being replaced by a more holistic chronic, immune-mediated disapproach guided by all of a ease, but the ability to quantify, for patient’s needs that also takes into the first time, other dimensions of consideration a patient’s disease health that psoriasis can affect. The severity, employment, underlying impact of psoriasis is broad, and health status, and economic and includes decreased physical and social status. mental well being and economic I believe that patients want consequences (Gelfand 2007, effective therapies that maintain Krueger 2001, Javitz 2002). It also clearance of psoriasis, provide includes multiple comorbidities, rapid response, are safe enough such as depression (Krueger 2001), for long-term use, and result in obesity (Herron 2005), myocardial minimal disruption to their daily infarction (Gelfand 2006a), and lives. Although many options are lymphomas (Gelfand 2006b). available, more than a third of peoWe are just at the infancy of ple with moderate or severe disbeing able to understand and ease — some of whom could likely quantify the economic impact of benefit greatly in multiple ways psoriasis. Early studies demonfrom treatment — still end up strate what we have suspected all without it (Horn 2007a). We hope along: psoriasis is associated with this will change, as it is clear that as an increased number of sick days health care providers, we now and causes financial distress for have much to offer these patients people who live with it (Finlay that may enable them to integrate 1995, NPF 2004). Psoriasis affects into the workplace and the com- munity in productive and satisfying ways. References Finlay AY , Coles EC. The effect of severe psoriasis on the quality of life of 369 patients. Br J Dermatol. 1995;132:236–244. Gelfand JM, Neimann AL, Shin DB, et al. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006a;296:1735– 1741. Gelfand JM, Shin DB, Neimann AL, et al. The risk of lymphoma in patients with psoriasis. J Invest Dermatol. 2006b;126: 2194–2201. Gelfand JM, Troxel AB, Lewis JB, et al. The risk of mortality in patients with psoriasis. Arch Dermatol. 2007;143:1493– 1499. Herron MD, Hinckley BA, Hoffman MS, et al. Impact of obesity and smoking on psoriasis presentation and management. Arch Dermatol. 2005;141:1527– 1534. Horn EJ, Fox KM, Patel V, et al. Are patients with psoriasis undertreated? Results of National Psoriasis Foundation survey. J Am Acad Dermatol. 2007a;57:957–962. Javitz HS, Ward MW, Farber E, et al. The direct cost of care for psoriasis and psoriatic arthritis in the United States. J Am Acad Dermatol. 2002;46:850–860. Krueger G, Koo J, Lebwohl M, et al. The impact of psoriasis on quality of life. Arch Dermatol. 2001;137:280–284. NIAMS (National Institute of Arthritis and Musculoskeletal and Skin Diseases). Questions and answers about psoriasis. U.S. Department of Health and Human Services Public Health Service. National Institutes of Health and NIAMS. NIH Publication NO. 03-5050. May 2003. «www.niams.nih.gov/ hi/topics/psoriasis/psoriasis.htm.» Accessed Nov. 3, 2008. NPF (National Psoriasis Foundation). Survey panels, Spring 2004 through Fall 2004. «http://www.psoriasis.org/research/ foundation/survey_panels.php». Accessed Oct. 7, 2008. Schmitt JM, Ford DE. Work limitations and productivity loss are associated with health-related quality of life but not with clinical severity in patients with psoriasis. Dermatology. 2006;213: 102–110. 5 http://www.niams.nih.gov/hi/topics/psoriasis/psoriasis.htm http://www.niams.nih.gov/hi/topics/psoriasis/psoriasis.htm http://www.psoriasis.org/research/foundation/survey_panels.php http://www.psoriasis.org/research/foundation/survey_panels.php

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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