Annual median health care expenses for depression and anxiety of $56 per patient was considered a high cost for adults in Canada with moderate to severe psoriasis who added tumor necrosis factor inhibitors or ustekinumab (TNFi/UST) treatment, and those discontinuing then restarting treatment with acitretin or experiencing additional conventional systemic treatment (CST) switches, according to study findings published in the Journal of the American Academy of Dermatology International.
More than 0.5% of the Canadian population have moderate to severe psoriasis, and due to pain, disability, inflammation, pruritus, and impaired quality of life, this population is at greater risk for anxiety and depression, researchers noted. Little is known of the economic burden of systemic treatment patterns and related mental health disorders in patients with psoriasis in Canada. Investigators sought to assess the health care costs for systemic treatment patterns and associated anxiety and depression among patients with psoriasis who began CST.
They conducted a retrospective cohort study of 781 patients using Quebec health administrative database information from January 2002 through December 2013. They assessed CST and TNFi/UST for 2 years following CST initiation of 8 treatment trajectories: persistent methotrexate users (25.8%), persistent acitretin users (10.4%), early CST discontinuation (36.6%), late methotrexate discontinuation (16.4%), switch to TNFi/UST (2.4%), adding TNFi/UST (1.4%), CST discontinuation then restart on methotrexate (3.8%), and CST discontinuation then restart on acitretin or multiple switches between systemic agents (3.1%).
Of the study population, 165 (21%) experienced anxiety- and depression-related health care costs (median annual cost CAN$56). Adding a TNFi/UST and discontinuation then restarting on acitretin or multiple CST switches had higher costs than persistent methotrexate use.
Investigators acknowledged study limitations to include trajectory misclassification, lack of data on reasons for treatment switch or discontinuation, at least 4 of 8 trajectories were underpowered, and biologic agents approved for psoriasis after 2015 were not considered.
Investigators concluded that among the treatment trajectories they identified, “patients adding TNFi/UST, those discontinuing their CST then restarting on acitretin or cyclosporine and patients with multiple CST switches, had higher rates of depression and anxiety and higher health care costs related to these conditions.”
Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Milan R, LeLorier J, Latimer EA, et al. Trajectories of systemic agent use and associated depression and anxiety-related healthcare costs among patients with psoriasis. J Am Acad Dermatol. Published online June 25, 2022. doi:10.1016/j.jdin.2022.06.018