| 1. |
- Ekelund, Mats, et al.
(författare)
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A Higher Score on the Dermatology Life Quality Index, Being on Systemic Treatment and Having a Diagnosis of Psoriatic Arthritis is Associated with Increased Costs in Patients with Plaque Psoriasis
- 2013
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Ingår i: Acta Dermato-Venereologica. - : Acta Dermato-Venereologica. - 0001-5555 .- 1651-2057. ; 93:6, s. 684-688
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine the relationship between measures of disease severity and costs from a socie-tal perspective in patients with plaque psoriasis. Dermatologists in Sweden recruited 443 consecutive patients who had had no biological treatment during the past 12 months. Following a Psoriasis Area and Severity Index (PASI) assessment, subjects completed self-assessments on health status/quality of life and a healthcare resource utilization/work status questionnaire. The costs of healthcare resources and sick-leave due to plaque psoriasis were estimated and related to the subject's health status. A patient's Dermatology Life Quality Index (DLQI) and being on systemic therapy, or having diagnosis of psoriatic arthritis, appeared to be more strongly associated with direct and indirect costs than did their PASI. The cost of biological therapy should be considered from the perspective of the already high costs of patients with high DLQI undergoing traditional systemic treatment.
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| 2. |
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| 3. |
- Mallbris, Lotus
(författare)
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Psoriasis : studies of phenotype at onset and of associated cardiovascular morbidity
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Psoriasis is a complex inflammatory skin disorder, affecting 2-3% of the population in the western world. The etiology of psoriasis is not yet known. However it is likely that its pathogenesis involves interplay between multiple genetic and environmental triggers. The aim of this thesis was to study psoriasis phenotypes at disease onset, to explore putative precipitating factors and to investigate cardiovascular morbidity in psoriasis. Firstly, we established the Stockholm Psoriasis Cohort (SPC), comprising 400 adults (<15 yr) with first-time incidence (<1 yr) of psoriasis disease: 74 had guttate psoriasis and 326 primarily had plaque psoriasis. Different environmental factors were implicated in different phenotypes: guttate psoriasis was associated with younger age and recent infection (84%), while the predominating factor associated with the onset of plaque psoriasis was a recent distinct life crisis (46%). Secondly, we examined whether or not the prevalence of streptococcal infections in guttate and plaque phenotypes varies in HLA-Cw*0602 positive and negative individuals. Three hundred and seventy five individuals, either with guttate (n=68) or plaque (n=307) psoriasis, derived from the SPC, and a total number of 285 matched controls were included in the study. The study showed that, regardless of phenotype, the prevalence of streptococcal throat infections is double among HLA-Cw*0602 positive psoriatics compared with HLA-Cw*0602 negative patients. No increased prevalence of streptococcal infection was noted among control individuals. Thirdly to assess the risk for cardiovascular death among psoriasis patients, we used Swedish nation-wide registries to follow up both inpatients and outpatients with psoriasis for cardiovascular mortality. In a cohort of 8991 psoriatic inpatients, followed until 1995, cardiovascular mortality was 50% greater compared with the general population. There was a gradual increase in risk with increasing duration of follow-up, and with increasing number of admissions. The relative risk of death from cardiovascular disease was highest among patients who were admitted at a young age, whereas psoriasis outpatients had no increase in risk. The underlying pathogenesis for such a correlation remains unclear. However multiple factors including systemic inflammation, oxidative stress, aberrant lipid profile and concomitant established risk factors have been discussed. Fourthly, to assess the blood lipid profile in patients with psoriasis at the initial stage of the disease, 200 patients derived from the SPC were investigated, comparing plasma concentrations of lipids, lipoproteins and apolipoproteins with those of matched controls. Psoriasis patients manifested significant dyslipoproteinemia. Specifically, patients had significantly higher cholesterol concentrations in the verylow-density and high-density lipoprotein fractions compared with controls. Adjustment for established environmental risk factors did not affect the results.
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| 4. |
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| 5. |
- Nordenfelt, Patrik, et al.
(författare)
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Hereditary Angioedema in Swedish Adults: Report From the National Cohort
- 2016
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Ingår i: Acta Dermato-Venereologica. - : ACTA DERMATO-VENEREOLOGICA. - 0001-5555 .- 1651-2057. ; 96:4, s. 540-545
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Tidskriftsartikel (refereegranskat)abstract
- Hereditary angioedema (HAE) is rare, disabling and sometimes life-threatening. The aim of this study is to describe its prevalence, symptomatology and treatment in Sweden. A total of 146 patients were identified; 110 adults and 36 children with HAE type I (n = 136) or II (n = 10), giving a minimum HAE prevalence of 1.54/100,000. All patients received a written questionnaire followed by a structured telephone interview. This report focuses on the 102 adults who responded. Females reported 19 attacks in the previous year vs. 9 for males (p < 0.01), and females reported 10 days of sick leave vs. 4 days for males (p < 0.05). For all treated acute attacks, plasma-derived Cl-inhibitor concentrate (pdClINH) (used in 27% of patients) had a good effect. For maintenance treatment, 43% used attenuated androgens and 8% used pdClINH, which reduced their attack rate by more than 50%. In conclusion, the minimum HAE prevalence in Sweden was 1.54/100,000. HAE affected females more severely. Attenuated androgens and pdClINH had a good effect on preventing attacks.
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| 6. |
- Nordenfelt, Patrik, et al.
(författare)
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Quantifying the burden of disease and perceived health state in patients with hereditary angioedema in Sweden
- 2014
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Ingår i: Allergy and Asthma Proceedings. - : OceanSide Publications; 1999. - 1088-5412 .- 1539-6304. ; 35:2, s. 185-190
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Tidskriftsartikel (refereegranskat)abstract
- Hereditary angioedema (HAE) due to C1 inhibitor deficiency is a rare disease characterized by attacks of edema, known to impact quality of life (QoL). This study investigates the burden of HAE in Swedish patients, both children and adults. We used a retrospective registry study of Swedish patients with HAE, captured by the Sweha-Reg census. Data were collected using a paper-based survey. Patients completed EuroQoL 5 Dimensions 5 Levels (EQ5D-5L) questionnaires for both the attack-free state (EQ5D today), and the last HAE attack (EQ5D attack). Questions related to patients age and sex and other variables, such as attack location and severity, were included to better understand the burden of HAE. EQ5D-5L values were estimated for the two HAE disease states. Patient-reported sick leave was also analyzed. A total of 103 responses were analyzed from 139 surveys (74% response rate). One hundred one reported an EQ5D today score (mean, 0.825) and 78 reported an EQ5D attack score (mean, 0.512) with significant differences between the two states (p less than 0.0001). This difference was observed for both mild (p less than 0.05), moderate (p less than 0.0001), and severe attacks (p less than 0.0001). Attack frequency had a negative effect on EQ5D today. Patients with greater than30 attacks a year had a significantly lower EQ5D today score than those with less frequent attacks. Of 74 participants, 33 (44.6%) had been absent from work or school during the latest attack and, of those with a severe attack, 81% had been absent. HAE has a significant impact on QoL both during and between attacks and on absenteeism during attacks.
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| 7. |
- Nygren, Anders, et al.
(författare)
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Swedish children with hereditary angioedema report good overall health and quality of life despite symptoms
- 2016
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Ingår i: Acta Paediatrica. - : WILEY-BLACKWELL. - 0803-5253 .- 1651-2227. ; 105:5, s. 529-534
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Tidskriftsartikel (refereegranskat)abstract
- AimFew studies have been published on children with hereditary angioedema (HAE), an autosomal dominant disease caused by mutations on chromosome 11. This study explored various aspects of the disease in the Swedish paediatric population. MethodsA retrospective questionnaire was sent to all 36 Swedish children known to have HAE, and a physician carried out follow-up telephone interviews. ResultsMost of the questionnaires were completed by the parents of 31 (86%) children with HAE, with or without their input, at a median age of nine years (range 1-17), and the physician also interviewed 29. HAE symptoms were experienced by 23 children, including abdominal attacks (96%), skin swelling (78%) and swelling in the mouth and/or upper airways (52%). Psychological stress was the most common trigger for abdominal attacks and trauma and sports triggered skin swelling. The majority (n = 19) had access to complement-1 esterase inhibitor concentrate at home. Current health and quality of life were generally rated as good, independent of whether the child had experienced HAE symptoms or not. ConclusionMost children with HAE had experienced abdominal attacks and skin swelling, but their overall health and quality of life were generally perceived to be good.
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| 8. |
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| 9. |
- Svedbom, Axel, et al.
(författare)
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Economic burden of psoriasis and potential cost offsets with biologic treatment : A swedish register analysis
- 2016
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Ingår i: Acta Dermato-Venereologica. - : Medical Journals Sweden AB. - 0001-5555 .- 1651-2057. ; 96:5, s. 651-657
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Tidskriftsartikel (refereegranskat)abstract
- Estimates of direct and indirect costs of psoriasis are limited. The aim of this study was to estimate: (i) costs in patients with psoriasis compared with controls; and (ii) impact on costs from initiating biologics. The study extracted data from Swedish administrative registers and compared 31,043 patients with 111,645 sex-, age- and residency-matched referents. Mean direct and indirect costs were estimated as US dollars (USD) 1,365 (62%) and USD 3,319 (50%) higher in patients compared with referents, respectively. The study included 352 patients treated with biologics who had at least 1-year follow-up before and after initiation of biologics. Among the 193 patients persistent with biologics for one year, 1-year costs of biologics were estimated at USD 23,293 (95% confidence interval (95% CI) 22,372−24,199). This cost was partially offset, with savings in direct costs estimated to range from USD –1,135 (95% CI –2,050 to –328) to USD –4,422 (95% CI –6,552 to –2,771), depending on assumptions. The corresponding estimates for indirect costs savings were from USD –774 (95% CI –2,019−535) to USD –1,875 (95% CI –3,650 to –188). The study suggests that psoriasis is associated with substantial costs, which may be modifiable with treatment.
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| 10. |
- Svedbom, Axel, et al.
(författare)
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Increased Cause-specific Mortality in Patients with Mild and Severe Psoriasis: A Population-based Swedish Register Study
- 2015
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Ingår i: Acta Dermato-Venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 95:7, s. 809-815
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Tidskriftsartikel (refereegranskat)abstract
- Several studies have shown excess risk for a number of comorbidities in patients with psoriasis compared with the general population, but data on cause-specific mortality in this patient population are limited. The aim of this study was to estimate the associations of psoriasis and 12 specific causes of death and all-cause mortality in patients with mild and severe psoriasis. The study was based on data from Swedish administrative registers and compared the risk of death in 39,074 patients with psoriasis with 154,775 sex-, age- and residency-matched referents using Cox proportional hazards models. In patients with mild and severe psoriasis, the strongest associations were observed for deaths due to kidney disease (hazard ratio [HR]=2.20, p<0.01) and liver disease (HR=4.26, p<0.001), respectively. Whilst cardiovascular disease was the main driver of excess mortality in absolute terms, the risks for other causes of death were also substantially elevated in patients with psoriasis compared with matched referents.
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