South may be best region for patients with psoriasis

For U.S. patients with moderate to severe psoriasis, the South may be the best region to live, with the Midwest as the least ideal region, based on health care use and costs, according to a study.

“Because psoriasis follows a chronic course of flares and remissions, the National Psoriasis Foundation recommends consistent outpatient care to minimize disease burden,” Khoa B. Nguyen, BS, of the University of Central Florida College of Medicine, Orlando, and colleagues wrote in Journal of the American Academy of Dermatology. “However, many U.S. patients lack regular access to care for their psoriasis and thereby experience poor clinical outcomes.”

In the cross-sectional study, Nguyen and colleagues analyzed health care use and costs of 13,632,547 U.S. patients with psoriasis from the 1996-2015 Medical Expenditure Panel Survey in the four U.S. Census regions: the West (21.3%), the South (35.3%), the Midwest (23.4%) and the Northeast (20%).

In the analysis, health care use was measured by ambulatory visits per patient per year (PPPY), the proportion of patients with one or more ED visits and the number of psoriasis-specific prescription drugs PPPY.

Health care costs were measured by the annual payments for ambulatory visits, ED visits and psoriasis-specific prescription drugs, including out-of-pocket and insurance payments.

The West had 61.3% more ambulatory visits PPPY compared with the rest of the U.S. (5.0 vs 3.1 visits PPPY); however, the mean health care costs in the West were less than the rest of the country at $2,141 PPPY vs. $3,161 PPPY (P = .035). Nguyen and colleagues attributed this to lower prescription drug costs in the West, which were, on average, $1,189 PPPY compared with $1,900 PPPY for the rest of the country (P = .023).

The data revealed that 9.1% of patients in the South used biologic medications per year compared with 6.4% for the rest of the United States (P = .045). The proportion of patients in the South had fewer ED visits per year than the rest of the country (1.19% vs. 1.96%).

The Midwest had the lowest mean proportion of patients using biologic medications at 5.2%. Patients in the Midwest spent $540 less on ambulatory costs PPPY (P < .001) and had 24.1% fewer ambulatory visits than the rest of the country.

Patients in the Northeast spent 53.9% more per year on health care than patients in the rest of the United States ($4,106 vs. $2,668 PPPY). The Northeast also had 96.1% higher ambulatory costs than the rest of the country ($1,321 vs. $673; P < .001).

Nguyen and colleagues said that southern U.S. states have the greatest access to biologic medications and had fewer ambulatory and ED visits than the rest of the country, whereas the Midwest had the least access to biologic medications and ambulatory and ED care.

“When psoriasis is well controlled with advanced therapies, patients may not need to visit their dermatologists or the ED as frequently,” Nguyen and colleagues wrote. “This study shows that the least ideal place to live for patients with psoriasis appears to be the Midwest because of significant barriers in access to care.”