A systematic review on methods used to evaluate patient preferences in psoriasis treatments.

In the treatment of psoriasis and psoriatic arthritis, recently approved medications undergo the 'early benefit assessment' in Germany. Psoriasis treatments differ in a multiplicity of characteristics like side-effects, beneficial effect, cost and process attributes, which serve to evaluate the patient-relevant benefit compared to standard treatments. Patient preferences might help to aggregate the various patient-relevant outcomes into a single measure. In this context, besides the calculation of the quality-adjusted life-years (QALYs), the Institute for Quality and Efficiency in Health Care (IQWiG) refers to methods of multi-criteria decision making or preference evaluation like analytic hierarchy process and conjoint analysis. The objective was to give an overview of methods that have been used in international published studies to evaluate patient preferences in psoriasis treatments. The review is based on a systematic literature research on December 2014 in selected electronic databases, using the keywords 'psoriasis' and 'preferences' as well as the name of specific methods, known from the literature to evaluate patient preferences. The search resulted 389 hits without duplicates. 21 articles met the inclusion criteria. Depending on the study objective, preferences were elicited for health states, health state domains, treatment attributes or treatment alternatives focusing on different outcomes of preferences. Thereby, different methods were used in included studies. For this reason, there is no single outcome available that might be useful in the benefit assessment of the IQWiG. Willingness-to-pay, often included as part of a conjoint analysis, was the predominant method to elicit preferences. So far, the analytic hierarchy process has not been used in psoriasis studies. The use of this method in future studies might provide new essential knowledge in the evaluation of patient preferences in psoriasis treatments. However, a clear assignment when to use which method is not given by the IQWiG and should be prioritized.

Patient benefits in the treatment of psoriasis: long-term outcomes in German routine care 2007-2014.

BACKGROUND: Psoriasis is associated with significant patient burden. Few studies have specifically measured patient preferences and benefits. OBJECTIVES: Outcomes assessment using the Patient Benefit Index (PBI) in nationwide psoriasis surveys comparing health care in 2007 and 2014. METHODS: This was a non-interventional, cross-sectional survey conducted in 2007 and 2014 in randomly selected dermatological practices and clinics recording by a) physicians: comorbidity, clinical severity (PASI, GCA), and b) patients: quality of life (DLQI, EQ-5D), patient-relevant therapeutic benefits (PBI) and previous and curent treatments. RESULTS: In 2014, a total of n = 1265 patients (43.4% female, mean age 51.9 ± 14.3 years.; mean disease duration 21.6 ± 15.4 years.) were included. Overall PBI was 2.8 ± 1.1. A total of 91.6% of patients showed a more than minimum clinically relevant benefit (PBI>1). Patients treated with biologics and biologics combined with conventional systemics showed the highest benefit compared to patients with conventional systemic treatment and patients treated with topical steroids. In comparison with the 2007 survey (n = 2009), there was an increase in PBI from 2.5 ± 1.1 to 2.8 ± 1.1 and a gain of patients with high benefits (PBI ≥3) by 30% (38.5% vs. 49.4%). CONCLUSION: In German routine care, psoriasis patients have shown increased therapeutic benefits over time with highest benefits deriving from biologics combined with systemics.

[Care for skin cancer in Germany : Provision and providers]. / Versorgung des Hautkrebses in Deutschland : Leistungsvolumina und -erbringer.

BACKGROUND: Treatment for skin cancer is a major component of dermatological care in western countries. OBJECTIVE: The purpose of this work is to analyze health care provision and providers for skin cancer care in Germany. METHODS: From the complete claims data set from 2007-2009 of the German statutory health insurance DAK (approximately 6.1 million insured persons), insurees with skin cancer and melanocytic naevi were extracted by ICD-10 codes. Surgical procedures and physician specialties were identified by specific codes. Data from the German statistical agency (Destatis) were derived from public domain for the years 2008-2010. RESULTS: Among the annual ambulatory surgical treatments (n = 6695) for melanoma, 83.6 % were conducted by dermatologists, followed by general surgeons (11.1 %), and facial surgeons (3.0 %). In melanocytic naevi (n = 51,659), 79.1 % were treated by dermatologists, followed by general surgeons (15.5 %), facial surgeons (3.6 %), and general practitioners (1.1 %), while in epithelial cancers (ICD-10 C44), 76.4 % were operated by dermatologists, followed by general surgeons (12.7 %) and facial surgeons (7.9 %). Overall, related to Germany, about 830,000 ambulatory operations for skin cancer were conducted in 2009 which is about 40 % more than in 2007. In hospitalized patients, 79,448 out of 195,558 inpatient cases (45.5 %) were treated in dermatological departments in the year 2012. Average annual growth rates of the inpatient cases in the DAK between 2007 and 2010 were 8.9 % for MM and 11.1 % for SCC/BCC. CONCLUSION: Skin cancer is associated with a significant and still growing need for surgical care in which dermatology has a leading role in Germany. Thus, there is an increasing need for dermato-surgical specialist training.

Patient preferences for psoriasis treatments: impact of treatment experience.

BACKGROUND: Patient preferences for psoriasis treatments can impact treatment satisfaction and adherence and may therefore influence clinical outcome. OBJECTIVE: To assess the impact of treatment experience (satisfaction with current treatment, number of prior visits, disease duration, number of preceding therapies and currently prescribed treatment modalities) on treatment preferences. METHODS: A computer-based conjoint analysis experiment was conducted to analyse preferences of patients with moderate or severe psoriasis (n = 163) treated at a German University Medical Center for outcome (probability, magnitude and duration of benefit; probability, severity and reversibility of side effects) and process attributes (location, frequency, duration, delivery method, individual cost) of psoriasis treatments. Relative importance scores (RIS) were calculated for each attribute and compared using anova, post hoc test and multivariate regression analysis. RESULTS: Participants with longer disease duration attached significantly greater importance to duration of benefit (ß = 0.206, P = 0.018), whereas participants on oral therapy were more concerned about magnitude of benefit by trend (ß = 0.218, P = 0.058). Participants receiving injectables not only set higher value to probability of benefit (RIS = 32.80 vs. 21.89, P = 0.025) but also to treatment location (RIS = 44.74 vs. 23.03, P = 0.011), delivery method (RIS = 43.75 vs. 19.29, P = 0.019), treatment frequency (RIS = 31.24 vs. 16.89, P = 0.005) and duration (RIS = 32.54 vs. 16.57, P = 0.003) when compared with others. Treatment satisfaction was significantly higher in participants on infusions or injections compared with those on phototherapy and mere topical therapy. CONCLUSIONS: Treatment preferences may change over time course and with treatment experience. Participants on injectables attach great importance to efficiency and convenience of therapies, and are highly satisfied with their treatment.