Heart disease and mental health conditions more prevalent in psoriasis

Moderate-to-severe psoriasis and psoriatic arthritis patients are more likely than people without these conditions to have cardiovascular and mental comorbidities, as well as higher healthcare utilization and medical costs, primarily from pharmacy-related expenses, according to a recent retrospective study of U.S. Department of Defense patients.

Cancer, cardiovascular disease, depression, diabetes, metabolic syndrome and more have been associated with psoriasis and psoriatic arthritis. Having severe psoriasis is not only associated with a higher risk for these and other comorbidities, but also with earlier death, according to the study authors.

Researchers analyzed claims data from November 2010 to October 2015 for 7,249 adults in the U.S. Department of Defense with moderate-to-severe psoriasis and, or psoriatic arthritis and compared what they found to 72,490 matched controls. They looked at comorbidity and economic burden from the date patients were first diagnosed with psoriasis or psoriatic arthritis to a year from that date.

COMORBIDITIES

The researchers found dyslipidemia in 18.3 percent of cases versus 13.5 percent of controls. Hypertension was higher among those with moderate to severe psoriasis and, or psoriatic arthritis, at 13.8 percent compared to 8.7 percent, as well as obesity, at 8.8 percent versus 6.1 percent of controls. Type 2 diabetes mellitus also was more common among cases than in controls, but the difference was very slight.

While the burden of these comorbidities was slightly higher but not significant in this study, other researchers have found moderate-to-severe psoriasis and psoriatic arthritis are significantly associated with several cardiovascular and other comorbidities. For example, Prodanovich et al found, in a 2009 study published in the Archives of Dermatology, that moderate-to-severe psoriasis and, or psoriatic arthritis was associated with a greater than 70 percent increased odds of having ischemic heart disease, peripheral vascular disease and atherosclerosis. The greater likelihood of cardiovascular disease in Prodanovich’s study could be due to its older study population, the researchers note. While the mean age in this study was 48.1 years, the former study looked at men whose average age was older than 65.

Findings that were significant in this study were that adults with psoriasis or psoriatic arthritis were also more likely than those without the diseases to be on antidepressant and anxiolytic medications.

“According to the National Psoriasis Foundation, there is a growing body of evidence that suggests a prominent link between psoriasis and mental illness,” the authors write. “Our findings support the literature that mental health comorbidities such as depression and anxiety may be an important prevalent illness in the sample.”

HEALTHCARE UTILIZATION

During the follow-up, adults with psoriasis and, or psoriatic arthritis had higher inpatient costs at $2,196 versus $1,642; ambulatory costs, at $8,804 compared to $4,642; and emergency room expenses, at $432 versus $350. Differences in pharmacy costs between the groups stood out most, at $6,878 for the cases, versus $1,160 for controls.

Pharmacy costs have been shown in previous research to be a major driver of the economic burden from psoriasis and psoriatic arthritis, according to the authors. In the claims data they cited, almost all of those costs were attributed to biologics. In this study, researchers found pharmacy expenses contributed to about 37.6 percent of total all-cause costs, and nearly 80 percent of moderate-to-severe patients in the study had injections, during the follow-up. 

A year of healthcare costs was $18,311 among those with moderate to severe disease compared to $7,795 for controls.

“… a significant portion of the cost burden was attributed to moderate-to-severe [psoriasis] and, or [psoriatic arthritis],” they write.

And one can infer, according to the study, that the pharmacy burden for these patients can be attributed to biologic or non-biologics, including IV steroids and disease-modifying anti-rheumatic drugs.

Future research might look at the specific pharmacy use that’s driving up costs for these patients with the Department of Defense and how to better contain costs for military personnel and their dependents, according to the study.

DISCLOSURES

The study was funded by Janssen Scientific Affairs, and some of the authors have employment or consulting ties with Janssen or its parent company Johnson & Johnson.

REFERENCES

Reference: Seina Lee, Lin Xie, Yuexi Wang, Neel Vaidya & Onur Baser (2018) Comorbidity and economic burden among moderate-to-severe psoriasis and/or psoriatic arthritis patients in the US Department of Defense population, Journal of Medical Economics, DOI: 10.1080/13696998.2018.1431921