Processes of psoriasis health care in Germany long-term analysis of data from the statutory health insurances

Background: To evaluate health care provision for psoriasis patients, and to better allocate resources, precise knowledge of the health care situation is essential. The goal of this study is to analyze prescription behavior and resource utilization for psoriasis patients in Germany. Methods: We performed a secondary analysis of routinely collected psoriasis data from 2004-2007 from members of a nationwide statutory health insurance company (Gmunder Ersatzkasse). A descriptive analysis was done on physician care, hospitalizations, and medications and related costs. Results: 34,728 of the 913,145 continuously insured patients were diagnosed with psoriasis (one-year prevalence: 2.3-2.5 %). At the time of the initial diagnosis, 68 % of patients were treated by a dermatologist and 28 % by a general practitioner (GP). Over the next 21 months, the proportion of patients seen by a dermatologist decreased to 22 % and the proportion seen by a GP increased to around 70 %. 15.2 % of patients were absent at least once from work. 79.5 % received prescriptions with an average cost of (sic) 135 per patient per year. 97.5 % of patients received topical therapy; 11 % got systemic therapies. Biologics were given to about 0.1 % of patients. Significant differences in prescription behavior were seen between regions and physician groups. Conclusion: Psoriasis is an important economic and medical issue. The majority of insured patients take prescription therapies. Dermatologists are most often the first health care provider.