Phototherapy achieves significant cost savings by the delay of drug-based treatment in psoriasis

Background Although used for decades in psoriasis, access to phototherapy is becoming increasingly restricted. Besides patient inconvenience, this is in large part to do with a perception of "high cost." We previously reported a comprehensive analysis of direct and indirect phototherapy treatment cost. However, no robust data exist on the actual savings associated with providing phototherapy in the treatment pathway. Objectives To quantify the cost savings achieved by phototherapy by delaying alternative treatments. Methods Costs accruing through the UK-wide established treatment pathway with and without phototherapy were analysed. Direct and indirectly incurred drug treatment costs were calculated using drug tariff, laboratory cost, estate rates and clinic review costs. To enhance reliability, ranges of cost scenarios were calculated by varying parameters such as drug dosing. Results Medium annual cost savings per patient were 2200 pound [range: 1800- pound 2900] pound for NB-UVB, and 3700 pound [range: 2500- pound 5300] pound if both NB-UVB and PUVA courses were administered, respectively. As the provider treated 656 +/- 76 patients per year during the 6-year observational window, this amounted to savings of Mio pound 2.4 [range: Mio pound 1.6-Mio pound 3.4], even excluding additional non-modelled drug-associated costs (eg diagnostics, adverse event management). Since we only consider cost savings by delay of drug treatment for the duration of phototherapy, drug price reductions through biosimilar introduction only have a small effect. We provide spreadsheets allowing adaptation cost savings projections by varying input variables. Conclusions Healthcare providers may achieve significant cost savings by implementing and/or widening access to phototherapy.