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Would elimination of copayments for phototherapy decrease the cost of treating psoriasis with systemic biologics? A
Jason F Simpson1, Christopher B Yelverton, Rajesh Balkrishnan
1Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1071, USA.
Managed Care Interface
|August 9, 2006
Summary
High phototherapy copayments may drive psoriasis patients to more expensive biologic drugs. This shift increases patient out-of-pocket costs and managed care plan expenses, despite phototherapy
Area of Science:
- Dermatology
- Health Economics
- Pharmacoeconomics
Background:
- Phototherapy is an effective psoriasis treatment but often underutilized due to frequent visits and copayments.
- Injectable biologic therapies offer an alternative but are associated with high costs.
Purpose of the Study:
- To investigate the impact of altered phototherapy copayment strategies on the utilization of biologic treatments for psoriasis.
- To analyze the cost-effectiveness of phototherapy versus biologic therapies from patient and insurer perspectives.
Main Methods:
- Utilized published cost estimates for phototherapy and biologic treatments.
- Calculated annual patient and insurer expenses based on estimated copayments for both treatment modalities.
Main Results:
- Annual patient expenses for phototherapy ($1,800) significantly exceed out-of-pocket costs for biologics like etanercept ($840), alefacept ($405), and efalizumab ($780).
- Annual costs to managed care organizations (MCOs) range from $3,008 for phototherapy to $20,300 for etanercept.
Conclusions:
- Current phototherapy copayment structures may inadvertently encourage a shift towards more convenient but substantially costlier biologic treatments.
- This shift presents a significant financial burden on both patients and managed care plans, necessitating a review of cost-sharing strategies.