NPR piece on the costs of Psoriasis

How Psoriasis (and PsA) costs billions a year

The JAMA Dermatology review found that maintenance drugs cost $11,029 a year for people using traditional drugs, and $26,708 for biologics, based on 2010 numbers.

Yikes. Scary numbers. And that is just the drugs.

When I was at the PsA clinic one time, one of the researchers asked whether I would be willing to complete a survey about the financial burden of PsA. I did, and I kind of wish I hadn’t. Besides medication costs, he included things like the cost of domestic help, physical aids, grocery costs (convenience items vs other), transportation modifications, and then the biggie, lost income. The whole thing was pretty scary. Now that I have remembered doing that, I must inquire about that research. Or maybe we don’t wanna know.

I hear you, Seenie. There are a lot of hidden costs to diseases like P and PsA. What I found most troubling about the article were the comments. Hey y'all just use Crisco and sea salt and you'll be fine. Ach du lieber!

Well, let's see. For 2014, 8 months of a biologic, 9 of MTX, 12 of a couple of other things. Four rheumatologist visits, 6 blood draws, chest x-ray. Probably 7 or 8 orthopedics visits, 3 MRI's, a CT scan, more x-rays. Surgery. About 40 physical therapy visits, before and after. I'm sure I exceeded my income quite nicely.

That's before the costs Seenie mentions. How about shoes? Gotta be comfortable, supportive, and have some style, please. Hey, would my insurance cover these??

I got summary for my prescription costs for the year were over $100k alone. It's nuts.

Where does all the $ come from to pay for this? It kind of scares me. Imagine if it had to come out of our own pockets–I’d be without treatment! And I’ve been complaining about our high deductible of $7,000 a year.

It’s called insurance, or government support. You can understand why, in places where medical care is 100% covered, there are some pretty high hoops to jump through to get approved for that kind of treatment.

If I had to pay for my Enbrel out of pocket, well, we would have to sell our house and move into a cardboard box. And I’m only kidding about the box part of that. Having a disease like this is life changing, but not life destroying if you have insurance and/or a social safety net. It makes me sad to think that there are people who have neither, and who have to bear the full brunt of what PsA dishes out.

The research being conducted now suggests that cheaper in the long run to use biologic first, at least for RA. I’m not sure how that stacks up with PsA.

Wait ... $26,708 for biologics? When I was on Remicade, it was approximately$10,000-$12,000 every five weeks just for the infusion. Add in the x-rays, MRIs, pain meds, monthly bloodwork, etc. etc. etc. and, yeah, much more than $26,708. And then there's my out of pocket for compression gloves, socks and shoes that work on my feet, canes, specialized crutches, my paraffin bath (for hands), my home PT stuff, my TENS unit and replacement pads ... and the list goes on.

Mataribot, I've seen similar studies with PsA- that if you hit it hard with biologics at the beginning, there's a fighting chance of eventually being able to discontinue them without disease progression, at least for a time.

Seenie, selling the house to stay on a biologic is a tough call. Would you actually do that? I'd probably keep the house and suck it up, or else living under the bridge down the street really would be in our future. It's scary- my insurance is currently completely fouled up: finally found out yesterday after a month of phone calls that failed to send our completed application to the insurance company. I'll probably have to skip a few weeks of my biologic when the current box is empty next week, as I just can't take a chance on it's not being covered, and it will probably take a good month to get proof of the insurance that I have indeed paid for . . .

Then there's the mental cost/benefit analysis I've been doing. Is my particular health and comfort really worth the money that's been put out? Is anyone's? Is everyone's? Ugly questions, but we, as a society, are going to have to start talking about them.

I realize it comes from insurance and tax dollars, but with the high cost of health care, it’s hard to fathom there is enough money to pay for all of it. Even though there are many people contributing to the “pot”, I know health care in the U.S. is very expensive. Not to get political, but listening to the democrats and republicans arguing about it in the U.S. has been beyond annoying. I had a huge concern about the cost of biologics before starting Enbrel. Maybe this is crazy, but the question I was asking myself was am I worth this? Really. I needed to be positive I was sick enough to warrant the expense of this treatment. Louise, I’m glad you mentioned that because I know others have the same attitude as me. And, it’s definitely not that money hasn’t been unnecessarily spent on my health care–I’ve had tests and treatments along the way that turned out negative and probably not necessary. It was just knowing Enbrel is expensive when it comes to meds, and could be very costly over a lot of years.

Louise, my husband and I are both on pensions, and something would have to give if I had to pay out of pocket for the full cost of Enbrel. A drastic downsizing (to a small house or condo) would probably give me enough of a cache to offset the cost of the biologic while leaving me enough of my disposable income to enjoy the good health that Enbrel gives me. Fortunately, I don’t have to resort to that. In Canada, drugs are not covered by our universal health plan (as they are in the UK and Australia, for example). What we do have is a government plan which covers catastrophic drug costs. But the coverage comes with a geared-to-income deductible. I am grateful that the deductible, while substantial, still leaves me a good portion of my pension cheque.

The cost/benefit analysis is a tough one. But I’m sure that the cost of three joint replacements would pay for quite a few boxes of auto-injectors. (Not even talking about the costs of the co-morbidities that tag along with our untreated PsA.) Disability and loss of productivity is expensive to society as a whole. So yes, I think we are worth it.

True. That makes sense. I would think, too, that the cost of biologics will eventually come down.

The cost will come down, and then Biologics will be replaced by the next group of amazing and extremely expensive therapies. And the money keeps going round and round!

Lol (it’s not really funny–I just like your sarcasm)

Seenie said:

The cost will come down, and then Biologics will be replaced by the next group of amazing and extremely expensive therapies. And the money keeps going round and round!

Louise, I finally got 'round to looking at those orthopedic shoes. ROFL they are FAR AND AWAY too cool and too cute to be covered by your insurance. In my experience, insurance only covers army boots, the uglier the better.

Louise said
"That’s before the costs Seenie mentions. How about shoes? Gotta be comfortable, supportive, and have some style, please. Hey, would my insurance cover these??"

Sounds about right

Sybil, the costs are tremendous and it seems that no matter the model (private or nationalized health) it isn't sustainable. We can only hope for cheaper drugs and better diagnostics in the near future. I know the costs trigger all sorts of warnings in my insurance to the point that I get letters about signing up for services to help manage my long-term illness (which I assume is considered a way to decrease overall costs in some cases).

I know, Jane. But it isn’t a case of biologic costs or no costs. I looked up the cost of joint replacements this morning:
USA – $40-50K each
Canada – $15-20 each
And that’s just the surgery, not the physio or follow ups or eventual revisions. And if there are complications, that adds to the bill. Nor does it factor in the costs of co-morbidities which the biologics may prevent.
I have had three TJRs, and will have a fourth one of these days. The cost of those would cover five years of biologics in this country, or about ten in the US. So the math on costs of biologics isn’t simple.

I contacted the research clinic about that study, and I think they are going to send me some data. Just waiting for the OK from the authors. Interesting stuff.

The numbers posted here is rather irrelevant. We do not know what type of average it is nor do we know what the distro is. We don’t know if they are going by retail cost or what is actually paid. Statistics used as shock therapy is unethical and wouldn’t be used by any real scientists.