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Fulltext Cost-Effectiveness Analysis of Psoriasis Treatment Modalities in Malaysia

Azizam NA, Ismail A, Sulong S, Nor NM

Int J Health Policy Manag, 2019 07 01;8(7):394-402.
PMID: 31441276 DOI: 10.15171/ijhpm.2019.17

BACKGROUND: There is limited evidence detailing the cost-effectiveness of psoriasis treatments in the Asian region. Therefore, this study is aimed to evaluate the cost-effectiveness of 3 psoriasis treatments tailored for moderate to severe psoriasis, namely topical and phototherapy (TP), topical and systemic (TS), and topical and biologic (TB) regimens, respectively.
METHODS: This has been achieved by the participation of a prospective cohort involving a total of 90 moderate to severe psoriasis patients, which has been conducted at 5 public hospitals in Malaysia. The main outcome measures have been evaluated via cost and effectiveness psoriasis area severity index (PASI)-75 and/or body surface area (BSA) <5 and/or dermatology life quality index (DLQI) ≤5), estimated from the societal perspective over a 6-months duration. All costs are based on 2015's recorded Malaysian Ringgit (RM) currency.
RESULTS: Consequently, TS has been found to be the most cost-effective treatment with the lowest cost/PASI-75/and/or BSA <5 and/or DLQI ≤5, valued at RM9034.56 (US$2582.55). This is followed by TP, which is valued at RM28 080.71 (US$8026.93) and TB, valued at RM54 287.02 (US$15 518.06). Furthermore, one-way sensitivity analysis has highlighted the cost of medication as the most sensitive parameter.
CONCLUSION: Thus, the input from this study is helpful for policy-makers in determining the first line treatment for moderate to severe psoriasis with consideration of the costs and its effectiveness in Malaysia. This will consequently allow hospitals to justify and provide the essential resources for further research and development, as well as the adoption of better treatment options.

Matched MeSH terms: Psoriasis/diagnosis
Methotrexate toxicity presenting as ulcerated psoriatic plaques

Wong SM, Chong YT, Thevarajah S, Baba R

Australas J Dermatol, 2012 Feb;53(1):81-3.
PMID: 22309341 DOI: 10.1111/j.1440-0960.2011.00779.x

Methotrexate toxicity is known to cause erosions of existing psoriatic plaques, although rare. We describe two patients who developed painful ulcerated psoriatic plaques as an early presenting sign of methotrexate toxicity and review the risk factors associated with this manifestation.

Matched MeSH terms: Psoriasis/diagnosis
Objective assessment of psoriasis erythema for PASI scoring

Ahmad Fadzil MH, Ihtatho D, Affandi AM, Hussein SH

Annu Int Conf IEEE Eng Med Biol Soc, 2008;2008:4070-3.
PMID: 19163606 DOI: 10.1109/IEMBS.2008.4650103

Skin colour is vital information in dermatological diagnosis. It reflects pathological condition beneath the skin and commonly being used to indicate the extent of a disease. Psoriasis is a skin disease which is indicated by the appearance of red plaques. Although there is no cure for psoriasis, there are many treatment modalities to help control the disease. To evaluate treatment efficacy, PASI (Psoriasis Area and Severity Index) which is the current gold standard method is used to determine severity of psoriasis lesion. Erythema (redness) is one parameter in PASI. Commonly, the erythema is assessed visually, thus leading to subjective and inconsistent result. In this work, we proposed an objective assessment of psoriasis erythema for PASI scoring. The colour of psoriasis lesion is analyzed by DeltaL, Deltahue, and Deltachroma of CIELAB colour space. References of lesion with different scores are obtained from the selected lesions by two dermatologists. Results based on 38 lesions from 22 patients with various level of skin pigmentation show that PASI erythema score can be determined objectively and consistent with dermatology scoring.

Matched MeSH terms: Psoriasis/diagnosis*
A case series of dermatological emergencies - Erythroderma

Tan TL, Chung WM

Med J Malaysia, 2017 04;72(2):141-143.
PMID: 28473684 MyJurnal

Erythroderma can be life-threatening, primarily because of its metabolic burden and complications. It is mandatory to establish its etiopathology in order to facilitate precise and definitive management. This disorder may be the morphologic presentation of a variety of cutaneous and systemic diseases. Detailed history and thorough work-up is therefore essential. Management of erythroderma involves multi-disciplines with progress monitoring especially on signs and symptoms suggestive of acute skin failure induced complications. Early diagnosis and referral of erythroderma to centres with dermatological services is crucial and will directly affect the outcome of the patients.

Matched MeSH terms: Psoriasis/diagnosis
Area assessment of psoriasis lesion for PASI scoring

Ihtatho D, Fadzil MH, Affandi AM, Hussein SH

Annu Int Conf IEEE Eng Med Biol Soc, 2007;2007:3446-9.
PMID: 18002738

Psoriasis is a skin disorder which is caused by genetic fault. There is no cure for psoriasis, however, there are many treatment modalities to help control the disease. To evaluate treatment efficacy, PASI (Psoriasis Area and Severity Index) which is the current gold standard method is used to measure psoriasis severity by evaluating the area, erythema, scaliness and thickness of the plaques. However, the calculation of PASI can be tedious and subjective. In this work, we develop a computer vision method that determines one of the PASI parameter, the lesion area. The method isolates healthy (or healed) skin areas from lesion areas by analyzing the hue and chroma information in the CIE L*a*b* colour space. Centroids of healthy skin and psoriasis in the hue-chroma space are determined from selected sample. Euclidean distance of all pixels from each centroid is calculated. Each pixel is assigned to the class with minimum Euclidean distance. The study involves patients from three different ethnic origins having different skin tones. Results obtained show that the proposed method is comparable to the dermatologist visual approach.

Matched MeSH terms: Psoriasis/diagnosis*
Clinical profile, morbidity, and outcome of adult-onset generalized pustular psoriasis: analysis of 102 cases seen in a tertiary hospital in Johor, Malaysia

Choon SE, Lai NM, Mohammad NA, Nanu NM, Tey KE, Chew SF

Int J Dermatol, 2014 Jun;53(6):676-84.
PMID: 23967807 DOI: 10.1111/ijd.12070

BACKGROUND: Generalized pustular psoriasis (GPP) is a severe but rare variant of psoriasis. Our objective is to review the clinical profile, comorbidities, and outcome of patients with GPP.
MATERIALS AND METHODS: A retrospective note review of all patients with adult-onset GPP.
RESULTS: A total of 102 patients with adult-onset GPP were diagnosed between 1989 and November 2011, with a female to male ratio of 2 : 1. The mean age at onset of GPP was 40.9 years (range: 21-81 years). Acute GPP was the most common variant seen (95 cases), followed by four localized variants of GPP and three with annular pustular psoriasis. Fever and painful skin were present in 89% of patients, arthritis in 34.7%, and leukocytosis in 78.4%. Common triggers were systemic steroids (45 cases), pregnancy (17 cases), and upper respiratory tract infections (16 cases). A positive family history of psoriasis and GPP was present in 29% and 11%, respectively. Comorbidities included obesity (42.9%), hypertension (25.7%), hyperlipidemia (25.7%), and diabetes mellitus (23.7%). The mean duration of admission and pustular flare for acute GPP was 10.3 days (range: 3-44 days) and 16 days (range: 7-60 days), respectively. Fifty-four patients responded to systemic retinoid, 21 to methotrexate, eight to cyclosporine, and one to adalimumab, but recurrences were common.
CONCLUSIONS: Our study confirms the poor response of GPP to currently available anti-psoriatic agents, with frequent flare-ups. There is a need for a more effective targeted therapy for this condition.

Matched MeSH terms: Psoriasis/diagnosis