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Posted by D3forU on May 28, 2010

WHY IS PHOTOTHERAPY UTILIZATION IN THE UNITED STATES DECLINING?

Article Reference:

A 2004 article in the American Journal of Dermatology (Housman TS, Rohrback JM, Fleischer, AB Jr, Feldman SR. Phototherapy utilization for psoriasis is declining in the United States. J. Am Acad Dermatol. 2002: 46:557-559) substantiated the declining use of phototherapy and psoralen ultraviolet A-range (PUVA) light therapy for psoriasis in nonfederal and non–university-based settings and explored factors that may have contributed to “decreased utilization of a safe and effective treatment for psoriasis.”

Despite the many advantages of phototherapy treatment for psoriasis, which authors called “a mainstay of nontopical therapy for patients with psoriasis,” they cite many of the factors mentioned in the Kaiser Permanente discussion — primarily the associated time and cost requirements for both physicians and patients — for its declining use. Other possible factors mentioned included advances in the use of alternate forms of psoriasis therapy, in particular cyclosporine and acitretin, and the increased use of home light therapy or tanning beds.

STUDY RESULTS

Records of 598 psoriasis visits from 1993 to 1998 were used to estimate the experience of approximately 15 million office-based visits during which psoriasis was a diagnosis. The resulting estimates — a statistically significant decreasing trend over the 6-year period examined — showed decreases similar to that seen in the authors’ university-based practice.

There were 873,000 visits for UV light therapy in 1993-1994, 189,000 in 1995-1996, and 53,000 in 1997-1998 (P < .0001).

There were 175,000 psoralen visits in 1993-1994, 61,000 in 1995-1996, and 25,000 in 1997-1998 (P = .0053).

POSSIBLE REASONS

Physicians’ burden — Authors note that visits may be “too cumbersome and costly” for physicians, many of whom have less manpower available for medical dermatology services than more profitable cosmetic procedures. This burden includes equipment maintenance, staff time, facility space needs, and other fixed and marginal costs that may not be fully reimbursed, plus the need to accommodate changing documentation and regulatory requirements for the degree of physician supervision required.

New drugs, home light therapy — Advances in the use of alternate forms of psoriasis therapy, in particular cyclosporine and acitretin, and the advent of home light therapy or tanning beds may have enabled physicians and patients to side-step issues involved in the cost and time involved in phototherapy office visits.

Cost to patients: impact of co-pays — Changes in third-party reimbursement policies requiring a co-pay for each phototherapy session were also seen as discouraging patients from undergoing this safe and effective treatment in favor of more toxic but better reimbursed systemic options.

PUSH TO NOT ABANDON PHOTOTHERAPY
Yet despite these costs and inconveniences, the authors urge practitioners and their patients not to abandon this “safe and effective treatment for psoriasis,” saying, “Until safer, efficacious therapies become available, we believe it is essential that phototherapy remain accessible to patients with psoriasis.” They support efforts to raise awareness of its efficacy and safety, and encourage increased reimbursement rates, discontinuation of co-pays for each treatment session, and less restrictive regulatory requirements for treatment documentation and supervision.

http://www.skinandaging.com/article/7197

link to PubMed article

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