OBJECTIVES: There are limited data on indirect costs due to loss of work productivity (missed work time and impairment while working) among US patients with moderate-to-severe plaque psoriasis. Costs of productivity loss are estimated to account for 32% of the total burden of psoriasis. This study estimated the indirect costs of psoriasis by treatment-based disease improvement via Psoriasis Activity Severity Index (PASI) score change from an employer’s perspective.
METHODS: Psoriasis Work Productivity and Activity Impairment Questionnaire (WPAI) from baseline to week 16 from a phase 3b study (CLEAR) comparing the efficacy and safety of secukinumab vs. ustekinumab were analyzed. Both treatment arms were pooled for the analysis and stratified by 4 levels of PASI score change from baseline to 16 weeks: less than 50% improvement (PASI less than 50), 50%-74% improvement (PASI 50-74), 75%-89% improvement (PASI 75-89), and at least 90% improvement (PASI greater than or equal to 90). Percentage of work time missed and impairment while working captured by WPAI from baseline to week 16 for all trial subjects employed at baseline were used to estimate the percentage of overall work impairment due to psoriasis. Applying the national averages for full- and part-time employment, hours worked per week, and hourly wages from the US Department of Labor, we estimated the annual indirect costs due to loss of work productivity by level of PASI score change.
RESULTS: Overall work impairment due to psoriasis decreased with greater skin clearance (22.8% for PASI less than 50, 13.3% for PASI 50-74, 6.4% for PASI 75-89, and 4.9% for PASI greater than or equal to 90), with the majority of impairment being related to productivity loss at work (presenteeism) rather than missed work time (absenteeism). The productive work time missed due to psoriasis symptoms decreased with increasing psoriasis clearance: 8.2 hours lost/week and 427.4 hours/year for patients with PASI less than 50 (poorly controlled psoriasis), 4.8 hours/week and 250.3 hours/year for PASI 50-74, 2.3 hours/week and 120.2 hours/year for PASI 75-89, and 1.8 hours/week and 92.5 hours/year for PASI greater than or equal to 90. The annual indirect costs due to work productivity loss per employed psoriasis individual were estimated to be $10,147 for a person with PASI less than 50, $5,941 for PASI 50-74, $2,852 for PASI 75-89, and $2,196 for PASI greater than or equal to 90, respectively.
CONCLUSIONS: Among US working patients with moderate-to-severe psoriasis, those achieving PASI improvement greater than or equal to 90 were associated with a prominent increase in workplace productivity and reduction in annual indirect costs.
