OBJECTIVES: New psoriasis treatments offer the potential for clearing psoriasis more completely than was possible with previous treatments. Whether higher degrees of clearing are clinically meaningful has not been fully determined. The purpose of this study is to assess whether more complete clearing of psoriasis is associated with a reduction in indirect costs of the disease.
METHODS: The impact of psoriasis on work was determined using patient-reported Psoriasis Work Productivity and Activity Impairment Questionnaire (WPAI) data from a phase 3b study comparing the efficacy and safety of secukinumab vs. ustekinumab (CLEAR). Four levels of disease improvement were assessed at 16 and 52 weeks: Psoriasis Area and Severity Index (PASI) improvement of less than 50% (PASI <50), 50%-74% (PASI 50-74), 75%-89% (PASI 75-89), and at least 90% (PASI ≥90). Percentage of work time missed (absenteeism) and impairment while working (presenteeism) for both treatment arms were used to estimate the percentage of work impairment due to psoriasis over the previous 7 days. Data from the US Department of Labor were used to calculate the annual indirect costs due to loss of work productivity.
RESULTS: A total of 675 subjects were assigned to treatment and included in the analysis (secukinumab = 336, ustekinumab = 339). Work impairment due to psoriasis decreased with greater skin clearance at Weeks 16 and 52: 22.8% & 26.3% for PASI <50, 13.3% & 16.4% for PASI 50-74, 6.4% & 10.4% for PASI 75-89, and 4.9% & 6.9% for PASI ≥90, with the majority of impairment being related to presenteeism rather than absenteeism. Absenteeism also decreased with greater skin clearance (W16 & W52) - 8.2 & 9.5 hours lost/week (427 & 493 hours/year) for patients with PASI < 50, 4.8 & 5.9 hours/week (250 & 307 hours/year) for PASI 50-74, 2.3 & 3.7 hours/week (120 & 195 hours/year) for PASI 75-89, and 1.8 & 2.5 hours/week (93 & 130 hours/year) for PASI ≥90. Annual indirect costs due to work productivity loss per worker decreased with greater skin clearance at both time points (W16 & W52) - $10,147 & $11,708 for PASI <50, $5,941 & $7,282 for PASI 50-74, $2,852 & $4,619 for PASI 75-89, and $2,196 & $3,074 for PASI ≥90.
CONCLUSIONS: Among working patients with moderate-to-severe psoriasis, those achieving and sustaining PASI improvement ≥90 were associated with a prominent increase in workplace productivity and reduction in annual indirect costs. These results indicate that effective skin clearance may contribute to reduced productivity loss.
