The cost of systemic therapies for psoriasis increased so fast in recent years that it outpaced the inflation rates for all items and for prescription drugs overall, according to a report in the January issue of the Archives of Dermatology.
The costs for brand name psoriasis drugs increased an average of 66% from 2000 to 2008. In comparison, the cost of other consumer items rose by 26% and that of prescription drugs overall rose by 30% during the same interval.
Much of this increase in the cost of psoriasis therapies can be attributed to the high cost of newer biologic therapies relative to that of more traditional systemic treatments. The advent of brand name versions of older drugs also has hiked treatment costs, wrote Dr. Vivianne Beyer and Dr. Stephen E. Wolverton, both of Indiana University, Indianapolis.
The investigators devised a cost model for each systemic psoriasis therapy based on continuous, yearlong outpatient treatment, including the expenses for medications, office visits, and recommended laboratory tests and monitoring procedures. They did not include the costs of treatment for adverse effects, or indirect costs such as time missed from work.
The researchers then compared the direct annual costs of phototherapy, systemic agents, and biologics from 2000 through 2008. In general, “traditional therapies remain much more affordable than biologic therapies,” they said.
It has been reported that prescription drug costs in general are outpacing the inflation rate, and “this trend also applies to therapies for psoriasis,” the investigators wrote. “Costs for all psoriasis medications except methotrexate, cyclosporine, alefacept, and infliximab have increased at a substantially greater rate” than inflation.
The annual change in the price of systemic drugs varied widely during the study period, from a net decrease of 24% in the cost of methotrexate to a net increase of 316% in the cost of Oxsoralen-Ultra, a brand name version of methoxsalen.
Acitretin showed the second-largest rise in price, an increase of 158% between 2000 and 2008.
In contrast, the cost of one brand name version of cyclosporine, Neoral, did not increase at all and the cost of another, Gengraf, dropped by 4%.
“Therapies such as acitretin, adalimumab, efalizumab, and etanercept have increased in cost steadily every year, whereas methotrexate, cyclosporine, and alefacept have seen minor, if any, increases in price since 2000,” the authors said (Arch. Derm. 2010;146:46-54).
For drugs and biologics, the annual cost of treatment in 2008 ranged from a low of $1,197 for methotrexate to a high of $27,577 for alefacept. Phototherapy costs ranged from a low of $3,083 per year for UVB to a high of $7,288 for PUVA, including induction and maintenance costs.
Dr. Beyer reported no financial conflicts of interest. Dr. Wolverton reported that he is a consultant for Eli Lilly & Co. regarding psoriasis therapy, is a consultant for Amgen Inc. regarding etanercept, and received royalties from Elsevier Publishing for a textbook on dermatology drugs.