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Psoriasis is associated with increased mortality risk
P1901
P1903
Economic burden of comorbidities in patients with psoriasis Alexa Kimball, Harvard Medical School, Boston, MA, United States; Eric Wu, Analysis Group, Boston, MA, United States; Parvez Mulani, Abbott Laboratories, Abbott Park, IL, United States; Yanjun Bao, Abbott Laboratories, Abbott Park, IL, United States
Psoriasis is associated with increased mortality risk Alexa Kimball, Harvard Medical School, Boston, MA, United States; Annie Gue´rin, Analysis Group, Boston, MA, United States; Parvez Mulani, Abbott Laboratories, Abbott Park, IL, United States; Yanjun Bao, Abbott Laboratories, Abbott Park, IL, United States
Objective: To estimate the incremental economic burden associated with comorbidities in patients with psoriasis, accounting for psoriasis severity. Methods: The Ingenix Impact National Managed Care Database (1999-2004) was used. Adult patients with psoriasis who were continuously enrolled for $ 6 months after a randomly selected psoriasis diagnosis date were included. Study comorbidities, identified during the 6-month study period, included psoriatic arthritis, cardiovascular disease, depression, diabetes, hyperlipidemia, hypertension, obesity, cerebrovascular disease, and peripheral vascular disease. Comparisons for resource utilization and costs during the study period were made for patients with $ 1 comorbidity versus those with none and for patients with versus without a specified comorbidity. Adjusted incidence rate ratios (IRRs) and odds ratios (ORs) were estimated for resource utilization using negative binomial and logistic regression models, respectively. Adjusted incremental costs associated with comorbidities were reported using generalized linear models with log link and gamma distribution or two-part models. All models controlled for age, sex, and psoriasis severity (measured by type of treatment). Results: A total of 114,512 patients were included; 51% had $ 1 studied comorbidity. Hyperlipidemia (27%) and hypertension (25%) were the most prevalent comorbidities. Patients with comorbidities were more likely to experience urgent care (OR [95% confidence interval], 1.58 [1.51-1.65]) than patients without a comorbidity. They also had significantly greater rates of hospitalization (IRR, 2.27 [2.13-2.42]) and more frequent outpatient visits (IRR, 1.53 [1.52-1.55]). In particular, patients with cardiovascular disease had a rate of hospitalization more than four times greater (IRR, 4.19 [3.90-4.50]) than patients without cardiovascular disease. Compared with patients with no comorbidity, patients with comorbidities incurred $2184 (P \.001) more in total costs. The incremental costs of comorbidities were especially substantial for patients with cerebrovascular disease ($6191; P \.001).
Objective: To investigate psoriasis (Ps)-associated mortality risk for Medicare beneficiaries in the United States. Methods: This analysis used the 5% standard analytical file of the fee-for-service portion of the Medicare database (1998-2006). Medicare patients (pts) aged $ 65 years who were continuously enrolled in Medicare Parts A and B for $ 6 months were included. Pts with Ps were identified as those with $ 2 diagnoses of Ps (ICD-9CM: 696.1x) during the first 6 months of observed enrollment. Each pt with Ps was matched to three control pts (free of Ps and psoriatic arthritis [ICD-9-CM, 696.0x]) based on age, sex, and race. Comorbidities recorded during the first 6-month period were compared descriptively by cohort. Chi-square tests were used for categorical variables and Wilcoxon rank-sum tests were used for continuous variables. Time from enrollment to death was compared between pts with Ps and Ps-free controls using Kaplan-Meier survival analysis. Results were reported as mortality rates and differences between the 2 cohorts were evaluated using log-rank tests. Unadjusted mortality risk was estimated using a Cox proportional-hazards model. In addition, adjusted risk was estimated, controlling for age category and interaction terms between age categories and cohort.
Conclusions: Other research has shown that psoriasis confers an increased risk of cardiovascular disease and other comorbidities. This study demonstrates that economic burden is increased for patients with psoriasis and comorbidities.
Results: A total of 5513 pts with Ps and 16,539 matched control pts were included in the analysis. Mean 6 SD age was 71.3 6 6.8 years, 57.0% were women, and 91.6% were white. The median follow-up time was 7.0 years. Pts with Ps had significantly greater rates of comorbidities (eg, hypertension, diabetes, hyperlipidemia, cardiovascular disease, and anemia [all P \.001]). Over the observation period, 27.3% of pts with Ps and 25.4% of controls died (P ¼.006). Overall, the mortality risk was 10% greater for pts with Ps than for Ps-free pts (P ¼.002). Pts with Ps between the ages of 65 and 69 years experienced a 22.3% increased risk of mortality compared with control pts without Ps (P ¼ .002) in the same age category. Conclusions: Pts with Ps have a significantly greater risk of mortality than pts who do not have Ps. In this study, the Ps-associated mortality risk was greater for younger pts compared with the full sample population. Commercial support: This study is sponsored by Abbott Laboratories.
Commercial support: This study is sponsored by Abbott Laboratories.
P1904
P1902 Increased economic burden associated with moderate to severe psoriasis compared with mild psoriasis Alexa Kimball, Harvard Medical School, Boston, MA, United States; Andrew Yu, Analysis Group, Boston, MA, United States; Parvez Mulani, Abbott Laboratories, Abbott Park, IL, United States; Yanjun Bao, Abbott Laboratories, Abbott Park, IL, United States Objective: To compare the economic burden and health care use by patients with moderate to severe psoriasis (Ps) compared with those with mild Ps. Methods: The Ingenix Impact National Managed Care database was used to identify patients with Ps during the study period, defined as the 2003 calendar year. Patients aged 18 to 65 years with continuous enrollment during the study period and $ 1 diagnoses of Ps before the end of study period were selected. Selected samples were further stratified by Ps severity based on treatment patterns. Patients with moderate to severe Ps were defined as those who received $ 1 systemic therapies. Outcomes included total health care utilization and costs and their components (ie, prescription drug and medical costs including emergency department visits, hospitalizations, outpatient visits, and professional services). Multivariate logistic regression models and two-part models were used to estimate the increased health care utilization and incremental costs, respectively, among patients with moderate to severe versus mild Ps. The models controlled for age, sex, and comorbidities during the study period. Results: A total of 56,528 patients with Ps met the inclusion criteria. Patients with moderate to severe Ps (N ¼ 5248) had significantly greater total health care utilization than did patients with mild Ps (N ¼ 51,280; adjusted odds ratio [AOR], 4.82), including greater medical (AOR, 1.19), hospitalization (AOR, 1.19), and outpatient utilizations (AOR, 1.14; all P \.02). The adjusted incremental costs for moderate to severe versus mild Ps were $7517 for total health care costs, including $3886 for drug costs and $2814 for total medical costs. Conclusions: Increased Ps severity is associated with greater resource utilization and costs. Additional studies will be necessary to determine whether this increased economic burden is driven by the disease itself and/or associated comorbidities. Commercial support: This study is sponsored by Abbott Laboratories.
MARCH 2010
Burden of illness in patients with hidradenitis suppurativa Annie Gue´rin, Analysis Group, Boston, MA, United States; Parvez Mulani, Abbott Laboratories, Abbott Park, IL, United States; Shiraz Gupta, Abbott Laboratories, Abbott Park, IL, United States Objective: Hidradenitis suppurativa (HS) is a chronic, inflammatory, relapsing disease of the apocrine sweat glands of the skin. Patients present with nodules, abscesses, or fistulas and substantial discomfort and/or itching. In the United States, 1% to 2% of the general population has HS. This study compared resource utilization and incremental economic burden between HS patients and control patients without HS. Methods: The MarketScan claims database (2000-2006) was used to identify as HS patients those with at least one diagnosis of HS (ICD-9-CM: 705.83). Adult patients with HS continuously enrolled for $ 12 months after a randomly selected HS diagnosis date (index date) were included in the analysis. Each patient with HS was matched to 5 HS-free control patients by year of birth and sex. Comorbidity burden, medication use, and resource utilization were compared between patients with HS and HS-free controls during a 1-year follow-up period. Absolute and relative risks (RRs) were estimated for comorbidities and adjusted incidence rate ratios (IRRs) were estimated for resource utilization using negative binomial regression models. All models controlled for age, sex, Charlson comorbidity index (CCI), and health insurance plan type. Results: The analysis included 20,652 patients with HS and 103,260 HS-free control patients. The average patient age was 38.2 years; 73.9% were women. Patients with HS had a greater comorbidity burden than HS-free patients (CCI, 0.401 vs 0.199; P [ .001). A significantly greater percentage of patients with HS were diagnosed with depression compared with HS-free controls (7.5% vs 4.7%; P ¼ .0001). Compared with HS-free patients, patients with HS had significantly greater risks (per 100 patients) of diabetes (11.2 vs 4.6; RR, 2.5) and asthma (5.4 vs 3.1; RR, 1.7; both P \ .001). The most commonly used drugs were antidepressants (18.8% vs 13.2%; P ¼ .001) and analgesics (37.6% vs 19.3%; P ¼ .001). Patients with HS had significantly greater rates of emergency department visits (IRR, 2.49 [95% confidence interval, 2.35-2.63]), hospitalizations (2.47 [2.28-2.66]), and outpatient visits (2.31 [2.272.36]) compared with HS-free patients. Conclusions: Patients with HS experience significant comorbidity and economic burden compared with the HS-free population. Commercial support: This study is sponsored by Abbott Laboratories.
J AM ACAD DERMATOL
AB67
P1903
Economic burden of comorbidities in patients with psoriasis Alexa Kimball, Harvard Medical School, Boston, MA, United States; Eric Wu, Analysis Group, Boston, MA, United States; Parvez Mulani, Abbott Laboratories, Abbott Park, IL, United States; Yanjun Bao, Abbott Laboratories, Abbott Park, IL, United States
Psoriasis is associated with increased mortality risk Alexa Kimball, Harvard Medical School, Boston, MA, United States; Annie Gue´rin, Analysis Group, Boston, MA, United States; Parvez Mulani, Abbott Laboratories, Abbott Park, IL, United States; Yanjun Bao, Abbott Laboratories, Abbott Park, IL, United States
Objective: To estimate the incremental economic burden associated with comorbidities in patients with psoriasis, accounting for psoriasis severity. Methods: The Ingenix Impact National Managed Care Database (1999-2004) was used. Adult patients with psoriasis who were continuously enrolled for $ 6 months after a randomly selected psoriasis diagnosis date were included. Study comorbidities, identified during the 6-month study period, included psoriatic arthritis, cardiovascular disease, depression, diabetes, hyperlipidemia, hypertension, obesity, cerebrovascular disease, and peripheral vascular disease. Comparisons for resource utilization and costs during the study period were made for patients with $ 1 comorbidity versus those with none and for patients with versus without a specified comorbidity. Adjusted incidence rate ratios (IRRs) and odds ratios (ORs) were estimated for resource utilization using negative binomial and logistic regression models, respectively. Adjusted incremental costs associated with comorbidities were reported using generalized linear models with log link and gamma distribution or two-part models. All models controlled for age, sex, and psoriasis severity (measured by type of treatment). Results: A total of 114,512 patients were included; 51% had $ 1 studied comorbidity. Hyperlipidemia (27%) and hypertension (25%) were the most prevalent comorbidities. Patients with comorbidities were more likely to experience urgent care (OR [95% confidence interval], 1.58 [1.51-1.65]) than patients without a comorbidity. They also had significantly greater rates of hospitalization (IRR, 2.27 [2.13-2.42]) and more frequent outpatient visits (IRR, 1.53 [1.52-1.55]). In particular, patients with cardiovascular disease had a rate of hospitalization more than four times greater (IRR, 4.19 [3.90-4.50]) than patients without cardiovascular disease. Compared with patients with no comorbidity, patients with comorbidities incurred $2184 (P \.001) more in total costs. The incremental costs of comorbidities were especially substantial for patients with cerebrovascular disease ($6191; P \.001).
Objective: To investigate psoriasis (Ps)-associated mortality risk for Medicare beneficiaries in the United States. Methods: This analysis used the 5% standard analytical file of the fee-for-service portion of the Medicare database (1998-2006). Medicare patients (pts) aged $ 65 years who were continuously enrolled in Medicare Parts A and B for $ 6 months were included. Pts with Ps were identified as those with $ 2 diagnoses of Ps (ICD-9CM: 696.1x) during the first 6 months of observed enrollment. Each pt with Ps was matched to three control pts (free of Ps and psoriatic arthritis [ICD-9-CM, 696.0x]) based on age, sex, and race. Comorbidities recorded during the first 6-month period were compared descriptively by cohort. Chi-square tests were used for categorical variables and Wilcoxon rank-sum tests were used for continuous variables. Time from enrollment to death was compared between pts with Ps and Ps-free controls using Kaplan-Meier survival analysis. Results were reported as mortality rates and differences between the 2 cohorts were evaluated using log-rank tests. Unadjusted mortality risk was estimated using a Cox proportional-hazards model. In addition, adjusted risk was estimated, controlling for age category and interaction terms between age categories and cohort.
Conclusions: Other research has shown that psoriasis confers an increased risk of cardiovascular disease and other comorbidities. This study demonstrates that economic burden is increased for patients with psoriasis and comorbidities.
Results: A total of 5513 pts with Ps and 16,539 matched control pts were included in the analysis. Mean 6 SD age was 71.3 6 6.8 years, 57.0% were women, and 91.6% were white. The median follow-up time was 7.0 years. Pts with Ps had significantly greater rates of comorbidities (eg, hypertension, diabetes, hyperlipidemia, cardiovascular disease, and anemia [all P \.001]). Over the observation period, 27.3% of pts with Ps and 25.4% of controls died (P ¼.006). Overall, the mortality risk was 10% greater for pts with Ps than for Ps-free pts (P ¼.002). Pts with Ps between the ages of 65 and 69 years experienced a 22.3% increased risk of mortality compared with control pts without Ps (P ¼ .002) in the same age category. Conclusions: Pts with Ps have a significantly greater risk of mortality than pts who do not have Ps. In this study, the Ps-associated mortality risk was greater for younger pts compared with the full sample population. Commercial support: This study is sponsored by Abbott Laboratories.
Commercial support: This study is sponsored by Abbott Laboratories.
P1904
P1902 Increased economic burden associated with moderate to severe psoriasis compared with mild psoriasis Alexa Kimball, Harvard Medical School, Boston, MA, United States; Andrew Yu, Analysis Group, Boston, MA, United States; Parvez Mulani, Abbott Laboratories, Abbott Park, IL, United States; Yanjun Bao, Abbott Laboratories, Abbott Park, IL, United States Objective: To compare the economic burden and health care use by patients with moderate to severe psoriasis (Ps) compared with those with mild Ps. Methods: The Ingenix Impact National Managed Care database was used to identify patients with Ps during the study period, defined as the 2003 calendar year. Patients aged 18 to 65 years with continuous enrollment during the study period and $ 1 diagnoses of Ps before the end of study period were selected. Selected samples were further stratified by Ps severity based on treatment patterns. Patients with moderate to severe Ps were defined as those who received $ 1 systemic therapies. Outcomes included total health care utilization and costs and their components (ie, prescription drug and medical costs including emergency department visits, hospitalizations, outpatient visits, and professional services). Multivariate logistic regression models and two-part models were used to estimate the increased health care utilization and incremental costs, respectively, among patients with moderate to severe versus mild Ps. The models controlled for age, sex, and comorbidities during the study period. Results: A total of 56,528 patients with Ps met the inclusion criteria. Patients with moderate to severe Ps (N ¼ 5248) had significantly greater total health care utilization than did patients with mild Ps (N ¼ 51,280; adjusted odds ratio [AOR], 4.82), including greater medical (AOR, 1.19), hospitalization (AOR, 1.19), and outpatient utilizations (AOR, 1.14; all P \.02). The adjusted incremental costs for moderate to severe versus mild Ps were $7517 for total health care costs, including $3886 for drug costs and $2814 for total medical costs. Conclusions: Increased Ps severity is associated with greater resource utilization and costs. Additional studies will be necessary to determine whether this increased economic burden is driven by the disease itself and/or associated comorbidities. Commercial support: This study is sponsored by Abbott Laboratories.
MARCH 2010
Burden of illness in patients with hidradenitis suppurativa Annie Gue´rin, Analysis Group, Boston, MA, United States; Parvez Mulani, Abbott Laboratories, Abbott Park, IL, United States; Shiraz Gupta, Abbott Laboratories, Abbott Park, IL, United States Objective: Hidradenitis suppurativa (HS) is a chronic, inflammatory, relapsing disease of the apocrine sweat glands of the skin. Patients present with nodules, abscesses, or fistulas and substantial discomfort and/or itching. In the United States, 1% to 2% of the general population has HS. This study compared resource utilization and incremental economic burden between HS patients and control patients without HS. Methods: The MarketScan claims database (2000-2006) was used to identify as HS patients those with at least one diagnosis of HS (ICD-9-CM: 705.83). Adult patients with HS continuously enrolled for $ 12 months after a randomly selected HS diagnosis date (index date) were included in the analysis. Each patient with HS was matched to 5 HS-free control patients by year of birth and sex. Comorbidity burden, medication use, and resource utilization were compared between patients with HS and HS-free controls during a 1-year follow-up period. Absolute and relative risks (RRs) were estimated for comorbidities and adjusted incidence rate ratios (IRRs) were estimated for resource utilization using negative binomial regression models. All models controlled for age, sex, Charlson comorbidity index (CCI), and health insurance plan type. Results: The analysis included 20,652 patients with HS and 103,260 HS-free control patients. The average patient age was 38.2 years; 73.9% were women. Patients with HS had a greater comorbidity burden than HS-free patients (CCI, 0.401 vs 0.199; P [ .001). A significantly greater percentage of patients with HS were diagnosed with depression compared with HS-free controls (7.5% vs 4.7%; P ¼ .0001). Compared with HS-free patients, patients with HS had significantly greater risks (per 100 patients) of diabetes (11.2 vs 4.6; RR, 2.5) and asthma (5.4 vs 3.1; RR, 1.7; both P \ .001). The most commonly used drugs were antidepressants (18.8% vs 13.2%; P ¼ .001) and analgesics (37.6% vs 19.3%; P ¼ .001). Patients with HS had significantly greater rates of emergency department visits (IRR, 2.49 [95% confidence interval, 2.35-2.63]), hospitalizations (2.47 [2.28-2.66]), and outpatient visits (2.31 [2.272.36]) compared with HS-free patients. Conclusions: Patients with HS experience significant comorbidity and economic burden compared with the HS-free population. Commercial support: This study is sponsored by Abbott Laboratories.
J AM ACAD DERMATOL
AB67