Sandra Purwins

Cost-of-illness of chronic leg ulcers in Germany

Chronic wounds are important because of their frequency, their chronicity and high costs of treatment. However, there are few primary data on the cost‐of‐illness in Germany. The aim was to determine the cost‐of‐illness of venous leg ulcers (VLU) in Germany. Prospective cost‐of‐illness study was performed in 23 specialised wound centres throughout Germany. Direct, medical, non medical and indirect costs to the patient, statutory health insurers and society were documented. Thereover, health‐related quality of life (QoL) was recorded as intangible costs using the Freiburg quality of life assessment for wounds (FLQA‐w, Augustin). A total of 218 patients (62.1% female) were recruited consecutively. Mean age was 69.8 ± 12.0 years. The mean total cost of the ulcer per year and patient was €9569, [€8658.10 (92%) direct and €911.20 (8%) indirect costs]. Of the direct costs, €7630.70 was accounted for by the statutory health insurance and €1027.40 by the patient. Major cost factors were inpatient costs, outpatient care and non drug treatments. QoL was strikingly reduced in most patients. In Germany, VLU are associated with high direct and indirect costs. As a consequence, there is a need for early and qualified disease management. Deeper‐going cost‐of‐illness‐studies and cost‐benefit analyses are necessary if management of chronic wounds is to be improved.

German psoriasis registry PsoBest: objectives, methodology and baseline data.

The German psoriasis registry PsoBest records the long‐term efficacy, safety, patient benefit and treatment regimens of psoriasis.

Time Needed for Treatment Is the Major Predictor of Quality of Life in Psoriasis

Background: The literature on predictors of health-related quality of life in psoriasis is inconsistent. Objective: To assess potential predictors of quality of life in psoriasis. Methods: In a cross-sectional study involving 130 dermatological practices and outpatient clinics, data of 1,210 patients with psoriasis were collected. Quality of life was evaluated using the Dermatology Life Quality Index. Medical history, clinical and sociodemographic characteristics, therapy and health care features were used as independent variables in a backward multiple regression analysis. Results: Twelve predictors were included in the model explaining 38% of variance in quality of life. The strongest predictor was daily treatment time (β = 0.30), followed by patient-defined treatment benefit (β = –0.18), disease severity (β = 0.19) and treatment satisfaction (β = –0.16). Conclusion: Treatment burden requires special attention when quality of life in psoriasis is to be improved. Since the larger part of variance is left unexplained, further factors predicting quality of life have yet to be detected.

Quality of psoriasis care in Germany: results of the national health care study “PsoHealth3”

Two national surveys conducted in 2005 and 2007 indicated deficits in psoriasis care and induced the composition of the ‘‘National Goals for Health Care in Psoriasis 2010–2015’’. The aim of this work was to (1) evaluate the quality of care for patients with psoriasis in Germany, (2) compare this with prior psoriasis studies PsoHealth1 (2005) and PsoHealth2 (2007), and (3) review the implementation of national treatment goals. By means of a cross sectional study the following indicators of health care quality were collected: psoriasis severity (Psoriasis Area Severity Index (PASI) and proportion of PASI >20), quality of life (Dermatology Life Quality Index (DLQI) were corporated: proportion of DLQI >10), previous systemic treatment, inpatient treatment, and days absent from work due to psoriasis. Between January 2013 and March 2014, 1265 patients from 82 dermatological centres were included (mean age of 52 years). 9.2 % had a PASI >20 (2007: 11.6 %; 2005: 17.8 %). 21.3 % reported strong quality of life restrictions (DLQI >10) (2007: 28.2 %; 2005: 34.0 %). 59.5 % had received a systemic treatment at least once within the last 5 years (2007: 47.3 %; 2005: 32.9 %). 20.1 % were treated inpatient within the last 5 years (2007: 20.1 %; 2005: 26.9 %). The current data indicate a better health care situation for psoriasis in Germany. The implementation of the S3-Guideline and the ‘‘National Goals for Health Care in Psoriasis 2010–2015’’ could have been contributing factors.

Prevalence of Obesity in Patients with Psoriasis: Results of the National Study PsoHealth3.

Background: Psoriasis is frequently associated with obesity which possibly contributes to reduced treatment response. Objectives: Assessment of the prevalence of obesity in patients with psoriasis in Germany 2013/2014. Patients and Methods: The frequency of overweight and obesity was assessed by the body mass index (BMI) and evaluated according to the severity of psoriasis [Psoriasis Area and Severity Index (PASI)]. Results: This national, cross-sectional survey involved 83 dermatological practices and outpatient clinics, including 1,265 patients (mean age 52 years; 43.4% female). The BMI of patients with psoriasis in 2013/2014 was found to be 28.0 and therefore was significantly higher compared to that of patients with psoriasis in 2007 with a BMI of 26.9 as well as compared to the normal population in 2013 with an overall BMI of 25.9. Conclusions: The prevalence of obesity in patients with psoriasis is higher than in the normal population. The trend towards a higher BMI in patients with psoriasis continues over time.

Deutsches Psoriasis-Register PsoBest: Zielsetzung, Methodik und Basisdaten

Zusammenfassung Hintergrund: Das Deutsche Psoriasis-Register PsoBest erfasst die Wirksamkeit, Sicherheit, Patientennutzen und Modalitäten der Psoriasistherapie im Langzeitverlauf. Patienten und Methodik: In PsoBest werden Patienten mit mittelschwerer und schwerer Psoriasis bei Ersteinstellung auf ein konventionelles Systemtherapeutikum oder Biologikum eingeschlossen und über fünf Jahre beobachtet. Die Basisdaten der bis zum 31.12.2012 eingeschlossenen Patienten werden präsentiert und mit denen der bundesweiten Versorgungsstudie PsoHealth 2007 (n = 2 009) verglichen. Ergebnisse: In PsoBest sind 602 dermatologische Praxen und Kliniken gemeldet, von denen 199 bis zum 31.12.2012 n = 2 556 Patienten einschlossen (63 % Praxen, 37 % Kliniken). Initial Biologika erhielten n = 808 (316 Adalimumab, 34 Efalizumab, 209 Etanercept, 75 Infliximab, 22 Golimumab, 152 Ustekinumab) und konventionelle Systemtherapeutika n = 1 651 (928 Fumarsäureester, 518 Methotrexat, 161 Ciclosporin A, 191 andere Präparate oder PUVA-Therapie). Die Patienten in PsoBest hatten im Vergleich zu PsoHealth einen höheren mittleren Schweregrad (PASI 14,7 vs. 10,1; DLQI 11,0 vs. 7,5; EQ-5D VAS 54,0 vs. 64,5), kürzere Erkrankungsdauer (18,2 vs. 21,3 J.), niedrigeres Alter (47,3 vs. 51,5), sowie häufiger Anteile an Psoriasis-Arthritis (20,5 vs. 19,1 %) und Nagelpsoriasis (55,0 vs. 35,6 %). Patienten unter Biologika-Therapie waren im Durchschnitt jünger, häufiger männlich, schwerer erkrankt und wiesen eine höhere Komorbidität auf. Schlussfolgerungen: Die Patienten in PsoBest repräsentieren Psoriasispatienten mit hohem Schweregrad und starkem Leidensdruck.

Cost-of-illness of psoriasis - results of a German cross-sectional study

Though psoriasis poses a substantial chronic socio‐economic burden, few studies have addressed the economic impact in Germany.

Cost‐of‐illness of patients with lymphoedema

Chronic lymphoedema is characterized by a continuous need for medical treatment, many comorbidities and impaired quality of life. In Germany, about 4.5 million patients are affected by lymphoedema. Thus, lymphoedema causes high direct and indirect costs, even more in case of complications such as erysipelas and ulcers.

PSS8 COSTS-OF-ILLNESS OF ULCUS CRURIS IN GERMANY: RESULTS OF TWO APPROACHES

period: In the period of four as well as eigth – weeks course of treatment with imiquimod 5% cream, therapy resulted in significantly higher chance of achieving complete clearance. Patients treated with imiquimod more frequently achieved clearance level higher than 75% of baseline actinic keratoses compared with the subject in vehicle group. Adverse events were more frequently recorded within the group of subjects who received imiquimod in comparison with vehicle group. The chance of experiencing local skin reaction such as erythema, flaking/scaling/dryness, scabbing/crusting, oedema, vesicles, erosin/ulceration was significantly higher in experimental group. Imiquimod five percent cream versus vehicle in long time period: Imiquimod 5% cream used 3 times a week for 24 weeks was an effective treatment for actinic keratosis measured by the probability of achieving complete clearance and partial clearance rate (more than 75% reduction in baseline lesions). Frequency of adverse events and local skin reactions was higher during the imiquimod treatment in comparison with placebo. Imiquimod five percent cream versus vehicle in patient with solid organ transplants: Treatment with imiquimod 5% cream for 24 weeks in kidney, heart and liver transplant patients resulted in significantly higher probability of achieving complete and partial clearance rates of actinic keratoses. There were no significant differences in incidence of adverse events between groups. CONCLUSIONS: Imiquimod five percent cream appears to be effective and safe alternative therapy for the treatment of actinic keratoses.

PSS28 VENOUS LEG ULCER. COSTS-OF-ILLNESS OF IN GERMANY. A NATIONAL CROSS-SECTIONAL STUDY

PSS28 VENOUS LEG ULCER. COSTS-OF-ILLNESS OF IN GERMANY. A NATIONAL CROSS-SECTIONAL STUDY Purwins S,Augustin M, Herberger K, Debus S, Rustenbach SJ University Clinics of Hamburg, Hamburg, Germany, Asklepios Klinik Harburg, Hamburg, Germany OBJECTIVES: Assessment of the costs-of-illness of venous leg ulcers treated in German wound centers.METHODS: A nationwide cross-sectional studywas performed in 31 specializedwound centers, including officeand clinic-based dermatologists, surgeons, GPs and internists. Patients with confirmed diagnosis of venous leg ulcer(s) were consecutively recruited, interviewed and asked to fill standardized questionnaires. Major outcomes parameters were the direct, indirect and intangible costs related to the leg ulcers from the societal perspective. The patient case report forms included questions on former treatment, health related quality of life, patient-relevant treatment benefit (PBI) and quality of care. The physician questionnaire focused on clinical data, co-morbidity, co-medication, wound status, resource consumption and all relevant types of costs related to the treatment of venous leg ulcers.RESULTS: In total, n = 218 patients (mean age: 69.8 12.0 years, median = 71) were enrolled, including 62.1% women and 37.9% men. The median duration of ulceration was 7.0 years. The average total costs per patient summed up to €9569 per year, including €8658 of direct costs and €911 of indirect costs. The major proportions of direct costs were statutory health insurance costs (€7631) and out-of-pocket expenses (€1027). The most cost-driving factor was inpatient treatment (€3568), followed by non-drug treatment expenses (€740) and nursing fees in home care (€212). Health-related quality of life was considerably impaired in almost all of the patients, indicating high intangible costs of illness. CONCLUSIONS: Venous leg ulcers in Germany are associated with relevant direct, indirect and intangible costs suggesting early and qualified disease management. are associated with relevant direct, indirect and intangible costs suggesting early and qualified disease management.