Improving the quality of care in psoriasis

Psoriasis is a chronic inflammatory skin disease affecting approximately 2.5% of the European population, which totals approximately 15 million patients. Because of its chronic course, the social stigma and a high degree of comorbidity, psoriasis is of great clinical and socio-economic importance. Average annual costs of severe disease amount approximately €8000 per patient. Thanks to successful programs of experimental and clinical research, the mechanisms of psoriasis and the targets for treatment have been well characterised and a wide spectrum of therapeutic options is now available.

Briefly, mild forms of psoriasis are treated with topical agents, including steroids and vitamin D analogs. Systemic treatment is a domain of moderate-to-severe disease and includes conventional immunosuppressants such as methotrexate, cyclosporine and fumaric acids. Moreover, a larger number of biologics is becoming available (TNFa antagonists, IL-12/ IL-23 antagonists) or in the pipeline (further anti-TNFs, other blockers of immune function in psoriasis). Although it has been shown that the guideline-compliant use of these drugs leads to significant reductions in morbidity, disease burden and economic impact, in most countries there is only insufficient use of modern anti-psoriatics. Major reasons for this are reluctance of the high disease burden, the ignorance of comorbidity, which also needs to be treated systemically, and the lack of pharmacoeconomic expertise. The latter includes the conclusion that early intervention in psoriasis treatment warrants a better disease course and, in the longer term, better cost effectiveness.

In recent years, a series of collaborative initiatives between physicians and patient advocacy groups have been implemented in order to raise awareness of the need for improved psoriasis care, to intensify the implementation of guideline-compliant treatments and to encourage the medical society to make use of the existing spectrum of drugs. It has been shown in Germany that the consensus of national goals for health care in psoriasis and the great number of national and regional initiatives –including a patient registry and regional psoriasis networks – has led to a significant improvement of psoriasis care, as measured by hard quality indicators.(1)

In order to address these issues, a European Expert Working Group for Healthcare in Psoriasis (EEWGHP), comprising clinicians and patient advocacy group representatives, was convened. The EEWGHP worked between June 2010 and December 2011 to outline the specific issues in psoriasis care, and start developing clear goals and actions that would help to address them. In 2012, physician and patient authors from many European countries published a Psoriasis White Paper, entitled, A framework for improving the quality of care for people with psoriasis,(2) which summarises the need and the points of action for improved psoriasis care based on positive experiences such as those seen in Germany. In particular, it emphasises the cross-link between different medical specialties, healthcare authorities, the hospitals and patients. It is of particular importance that the hospital pharmacists – who in many countries participate in the distribution of antipsoriatic drugs – are aware of these activities in psoriasis care throughout Europe.

The White Paper is a key milestone for treatment in this disease area. The aim was to provide a framework for improving early access to high-quality care for people with psoriasis in Europe, through raised awareness and consistent management. Ultimately, it is hoped that this framework will help to raise treatment aspirations in psoriasis (of both healthcare professionals and people with psoriasis), thereby improving clinical outcomes and quality of life for people with this condition.

1. Augustin M et al. Co-morbidity and age-related prevalence of psoriasis: Analysis of health insurance data in Germany. Acta Derm Venereol 2010;90(2):147–51.
2. Augustin M et al. A framework for improving  the quality of care for people with psoriasis. J Eur Acad Dermatol Venereol 2012;26 Suppl 4:1–16.