Effect of heliotherapy on the cost of psoriasis

Solar Climate Features Taking into Account the Morphometric Conditions of the Area and the Possibility of Using Them in Heliotherapy on the Example of the Cieplice and Kołobrzeg Health Resorts (Poland)

Global solar radiation is an important atmospheric stimulus affecting the human body and has been used in heliotherapy for years. In addition to environmental factors, the effectiveness of global solar radiation is increasingly influenced by human activity. This research was based on the use of heliographic and actinometric data (1996–2015) and the model distribution of global solar radiation to determine the possibility of heliotherapy with the example of two health resorts: Cieplice and Kołobrzeg (Poland). The solar features of health resorts (sunshine duration and global solar radiation) were characterized, and they were correlated with the spatial distribution of global solar radiation data obtained with the use of remote sensing techniques (System for Automated Geoscientific Analyzes-SAGA), including COoRdination and INformation on the Environment (CORINE) land cover (CLC) data. Using the maximum entropy model (MaxEnt), a qualitative and quantitative relationship between morphometric parameters and solar climate features was demonstrated for individual land cover types. Studies have shown that the period of late spring and summer, due to the climate’s solar features, is advisable for the use of heliotherapy. The human activity that determines the land cover is the main element influencing the spatial differentiation of the possibilities of using this form of health treatment. It also affects topographic indicators shown as significant in the MaxEnt predictive model. In general, areas with high openness were shown as predisposed for health treatment using global solar radiation, which is not consistent with areas commonly used for heliotherapy. The conducted research has shown the need for an interdisciplinary approach to the issue of heliotherapy, which will contribute to the optimization of the use of this form of health treatment from the perspective of climate change and human pressure.

Systematic review of cost-effectiveness analyses of treatments for psoriasis

BACKGROUND

Psoriasis is a chronic inflammatory disease of the skin that has a major effect on an individual's physical and mental function. The disease is associated with increased healthcare resource use and costs, therefore cost-effectiveness analysis (CEA) can be used to assist decision makers with determining which treatments are optimal within a constrained healthcare system budget.

OBJECTIVES

Our aim was to systematically review the current literature on the CEA of existing treatment options for psoriasis, assess the quality of these studies, and summarize the evidence on the drivers of cost effectiveness.

METHODS

A literature search using Medical Subject Headings and keywords was performed in the MEDLINE, EMBASE and Health Technology Assessment databases, as well as the National Health Service Economic Evaluation Database; the CEA Registry was searched using keywords only. All references within the relevant review articles were examined manually. Two researchers independently determined the final articles and a third researcher resolved any discrepancies. We evaluated study quality in terms of the study perspective, effectiveness measures, cost measures, economic model, and time horizon. Any sensitivity analyses conducted in the studies were examined to identify the drivers of cost effectiveness, which included any variables leading to changes in the study conclusions.

RESULTS

Fifty-three articles were included in our final review: 70% did not explicitly include costs related to adverse events; approximately one-quarter used quality-adjusted life-years; and 34% applied a time horizon under 1 year. In 18 of the 38 studies that conducted a sensitivity analysis, the cost-effectiveness results were impacted by uncertainty. The main key drivers of cost effectiveness were the costs related to the treatment, values and choice of efficacy, utility values, hospitalization for non-responders, time horizon, model structure, and utility mapping method.

CONCLUSIONS

High-quality cost-effectiveness studies are required to facilitate resource allocation decision making. To improve study quality, future research should provide evidence on the long-term experience with psoriasis treatments, and resolve the uncertainty associated with key drivers of cost effectiveness.

Cost-of-illness in patients with moderate and severe chronic psoriasis vulgaris in Germany

BACKGROUND

Data regarding costs of outpatient and office-based care, as well as out-of-pocket expenses, for psoriasis patients in Germany are not available. Aim of this study was to assess average annual cost and cost per flare of outpatient and office-based care for patients with moderate to severe chronic psoriasis vulgaris from several perspectives.

METHODS

In this multi-center, cross-sectional, retrospective and prospective cost-of-illness study, direct (medical and non-medical) and indirect costs were considered from patient, third-party payer (TPP) and societal perspectives.

RESULTS

Out of 227 patients enrolled consecutively in 17 centers, 192 cases could be analyzed. On average, TPP reimbursed 864 per patient annually, 60 % for prescribed medication and 22 % for hospitalization. Patients spent 596 yearly mainly for alternative therapies and OTC-medication/skin care products as well as for additional expenses (e. g. ultraviolet lamp, clothes or cleaning agents). Indirect costs per patient amounted to 1,440 yearly. Total annual costs per patient were 2,866 and 4,985 if treated with systemic drugs additionally. 1,173 if treated topically and/or with phototherapy.

CONCLUSIONS

The relatively high average annual costs per patient indicate need for efficient control of psoriasis. This cost-of-illness study provides basic data for further decision making, including economic assessment of innovative therapies for psoriasis.

Monetary and nonmonetary costs to patients attending an ambulatory dermatology clinic

BACKGROUND

Despite universal coverage under a provincial health plan, the residents of Ontario, Canada, still bear some costs for outpatient care, particularly for prescription drugs.

OBJECTIVE

To determine the financial and nonmonetary costs borne by patients presenting at a dermatology clinic in an academic centre, and to assess the extent to which these costs were problematic.

METHODS

Consecutive new patients in a 6-week period completed a self-administered questionnaire.

RESULTS

Eighty-six of 140 questionnaires (61%) were returned for analysis. The mean total cost to patients was C$28.92 (range $0 to $177.00). Medications were the largest expense (mean $35.66 for those receiving medication). Despite relatively prompt referrals (mean 12.4 days) and short in-office waiting time (mean 26.5 minutes), there was a trend for subjects to rate time costs as more problematic than monetary costs.

CONCLUSION

Patients attending a dermatology clinic bear variable monetary and nonmonetary costs. For some patients these costs may have the potential to impair access to care.