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There is little published on the relative costs of treatments in psoriasis. OBJECTIVE: This study was designed to assess patterns of medicationuse, costs, and health care resource utilization among US managed care psoriasis patients. METHODS:Members of 4 HMOs were identified using pharmacy outpatient and hospital claims data for a 1-year period. Patients were selected if they had (1) at least 2 claims for psoriasis (ICD-9 code 696, 696.1, and/or 696.8) or (2) 1 claim for psoriasis and 1 claim for a psoriasis drug or phototherapy. Descriptive data were collected to determine psoriasis drug and therapy use, and total and psoriasis-specific costs. RESULTS:There were 2,868 members with psoriasis identified. The data showed that 47.4% of the patients were on monotherapy and 45% of the patients were on monotherapy and 45% of the patients were on polytherapy, defined as two or more of the psoriasis-specific drugs or therapies. This coincides with recent market evaluatoins of psoriasis therapies. Topical corticosteroids were used by 82% of the patients. Claims for photochemotherapy were made by 9% of members. Eighty percent of patients received therapy from a dermatologist. There were psoriasis-related hospitalizations for 11% of the patients. The median costs for psoriasis-related hospitalizations/patients were $252–$1,383 (range: $40–$18,933). Median total psoriasis-related costs/patient were $155–$170 (range: $0–$24,334). CONCLUSION:High potency topical corticosteroids remain the most commonly used medications for psoriasis. Even though few patients were hospitalized for psoriasis, the high costs of hospitalization made it one of the cost drivers of this condition. Phototherapy procedures, office visits for non-psoriasis-specific diagnoses, and total drug costs for psoriasis were additional cost drivers of psoriasis treatment.

American Heart Association Guidelines establish acceptable limits of carotid endarterectormy (CEA) postoperative morbidity/mortality at 7–9%. Based on these standard, early CEA (within 30 days of non-disabling stroke) has been safely performed. However, early CEA is not standard practice at many institutions. Decreasing the interval between stroke and surgery (SSI) may decrease the risk of recurrent stroke in the SSI and resource utilization through elimination of interval anticoagulation. OBJECTIVE: Clinical and economic outcomes of early and delayed (beyond 30 days) CEA in non-disabling stroke patients were examined. METHODS: Sixty-three patients were identified through a physician's office registry, the Thomas Jefferson University Hospital's clinical financial management system, and chart review as having had CEA for non-disabling stroke between November, 1991 and December, 1996. Details regarding SSI and perioperative (surgery to discharge) stroke, myocardial infarction (MI), and death were obtained from charts. Inpatient costs were extracted from clinical financial management systems for early and delayed group patients. Interval anticoagulation costs were estimated using established models in atrial fibrillation. RESULTS: Early Patients (n=43) Delayed Patients (n=20) % > 2 comorbidities 63% (27) 37% (7) Perioperative stroke rate 2.3% (1) 5% (1) MI/Death rate 0% (0) 5% (1) The average total cost of hospitalization per delayed group patient was $US11,337 (95% CI $9,217–$13,943). The cost of initial hospitalization and interval anticoagulation per delayed group patient was estimated to be $US3,119. The estimated total cost of treatment per patient in the early and delyed groups, respectively, was $US13,791 and $US14,455. CONCLUSION: This study suggests that early CEA can be performed with acceptable perioperative morbidity rates in selected non-disabling stroke patients. Decreasing the length of the SSI decreases the recurrent stroke risk and interval anticoagulation resource utilization.