A Cost Comparison of Treatments of Moderate to Severe Psoriasis

This study of the efficacy and cost-effectiveness of moderate to severe psoriasis treatments compared phototherapy, oral systemic agents, and biologics from a managed health care systems perspective. A literature review was conducted to identify published studies reporting Psoriasis Area and Severity Index (PASI) percentage improvement from baseline (PASI%) for selected treatments. The researchers then calculated total annualized costs. For each treatment, annualized cost-effectiveness was calculated by dividing total annualized costs of treatment by PASI%. The costs necessary to achieve clinically meaningful outcomes (PASI50 and PASI75) were then calculated. Of 3886 articles examined, 16 studies met inclusion criteria. Oral systemic medications, UV therapy, and UV therapy combined with acitretin appear to be the most cost-effective therapies for moderate to severe psoriasis

Measuring the quality of depression care in a large integrated health system

BACKGROUND: Guideline-based depression process measures provide a powerful way to monitor depression care and target areas needing improvement. OBJECTIVES: To assess the adequacy of depression care in the Veterans Health Administration (VHA) using guideline-based process measures derived from administrative and centralized pharmacy records, and to identify patient and provider characteristics associated with adequate depression care. RESEARCH DESIGN: This is a cohort study of patients from 14 VHA hospitals in the Northeastern United States which relied on existing databases. Subject eligibility criteria: at least one depression diagnosis during 1999, neither schizophrenia nor bipolar disease, and at least one antidepressant prescribed in the VHA during the period of depression care profiling (June 1, 1999 through August 31, 1999). Depression care was evaluated with process measures defined from the 1997 VHA depression guidelines: antidepressant dosage and duration adequacy. We used multivariable regression to identify patient and provider characteristics predicting adequate care. SUBJECTS: There were 12,678 patients eligible for depression care profiling. RESULTS: Adequate dosage was identified in 90%; 45% of patients had adequate duration of antidepressants. Significant patient and provider characteristics predicting inadequate depression care were younger age (\u3c65), black race, and treatment exclusively in primary care. CONCLUSIONS: Under-treatment of depression exists in the VHA, despite considerable mental health access and generous pharmacy benefits. Certain patient populations may be at higher risk for inadequate depression care. More work is needed to align current practice with best-practice guidelines and to identify optimal ways of using available data sources to monitor depression care quality