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At-Home UVB Therapy vs.
Systemic Therapies
Calculating the
Lifetime Cost of Care Compared to Other Therapies
Excerpted from Skin and Aging
ISSN: 1096-0120 , Vol 13, Issue 7_2005, July 2005, Pages 50-52
Authors: CB Yelverton, AS Kulkarni, R Balkrishnan, SR Feldman.
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At-home treatments with ultraviolet-B (UVB)
phototherapy can offer convenient, cost-effective and efficacious choice for treatment of your patients’ psoriasis.
Published studies indicate that efficacy of UVB phototherapy is anywhere from
60 % effective for broad-band UVB to nearly 80 % effective for narrow-band UVB for
treating psoriasis. To compare treatment options, researchers developed a
payer-perspective model to calculate the cost of home UVB
phototherapy, topical psoralen-UVA (PUVA), and other systemic treatments for
psoriasis such as acitretin, methotrexate, efalizumab (Raptiva) etanercept (Enbrel),
adalimumab (Humira) and alefacept (Amevive).
After gathering and analyzing the data, researchers
concluded that phototherapy continues to be “an effective and relatively
inexpensive option for many patients.” They further stated that “Insurers should
reduce disincentives to phototherapy treatment,” and that they should encourage
physicians to “make greater use of home phototherapy treatment options.”
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TABLE 1 |
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HOW THE
TREATMENTS COMPARE |
|
Treatment |
Annual Drug Cost |
Annual Treatment Administration |
Annual Laboratory |
Annual Follow-up |
Present Value of 30-year Course of
Treatment |
| Home UVB |
None |
$2,150 |
None |
$195 |
$7,085 |
| PUVA |
$398 |
$412 |
$241 |
$390 |
$19,102 |
| Methotrexate |
$816 |
$1,410 |
None |
$195 |
$37,591 |
| Acitretin |
$4,471 |
None |
$137 |
$293 |
$75,113 |
| Alefacept |
$10 ,702 |
None |
$73 |
$293 |
$171,915 |
| Efalizumab |
$16,198 |
None |
$9 |
$390 |
$257,684 |
| Adalimumab |
$17,818 |
None |
$9 |
$293 |
$281,282 |
|
Etanercept |
$17,910 |
$406 |
$1,597 |
$293 |
$319,356 |
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TABLE 2 |
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TREATMENTS AT A GLANCE |
|
Treatment |
Administration |
Dosage |
Treatment
Frequency |
Labs |
Other
Intervention |
Follow-up
(per year) |
| Home UVB |
N/A |
6 Minutes |
Every Other Day |
None |
None |
Four Times |
| PUVA |
Oral |
40 mg |
30 Treatments per Year |
None |
None |
Four TImes |
| Methotrexate |
Oral (Tablet) |
15 mg |
Weekly |
CBC & LFT
8 Times/yr |
Biennial Liver Bioposy |
Eight Times |
| Acitretin |
Oral |
25 mg |
Daily |
Lipids&LFT
4 Times/yr |
None |
Six Times |
| Alefacept |
Intramuscular
(In Office) |
15 mg |
18 Treatments per Year |
CD4 Count with Each
Injection |
None |
Six Times |
| Efalizumab |
Subcutaneous |
75 mg |
Weekly |
CBC
6 Times/yr |
None |
Six Times |
| Adalimumab |
Subcutaneous |
40 mg |
Every Other Week |
PPD at
Initiation |
None |
Six Times |
|
Etanercept |
Subcutaneous |
50 mg |
Weekly |
PPD at Initiation |
None |
Eight Times |
The Findings:
Home UVB therapy was the least expensive, costing about $7,100 for a 30-year
course of treatment. Table 1 shows comparisons. For more
information, see Table 2, Treatments at a Glance.
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