Uncovering Patient-Reported Outcome Differences Between Undiagnosed and Diagnosed Individuals With Moderate to Severe Psoriasis in Europe

OBJECTIVES: To compare demographics and patient-reported outcomes (health-related quality of life [HRQoL], work productivity and activity impairment [WPAI]), and healthcare resource use (HCRU) between diagnosed and treated vs. experiencing but undiagnosed individuals with moderate to severe psoriasis in the EU4 (France, Germany, Spain, Italy) and United Kingdom (UK).

METHODS: Data from the 2022 EU4+UK National Health and Wellness Survey (N=62,005), a nationally-representative, cross-sectional online survey, was analyzed. Respondents who self-reported experiencing moderate to severe psoriasis were stratified as having a physician diagnosis and use prescriptions (“diagnosed Rx”) vs. not having a physician diagnosis (“undiagnosed”). Demographics, HRQoL (RAND-36), WPAI, and HCRU were compared between groups using bivariate statistics.

RESULTS: Among moderate/severe psoriasis individuals in the EU4+UK (undiagnosed n= 379, diagnosed Rx n= 717), undiagnosed were younger with 53.3% falling into the 18-34 age bracket compared with 16.9% diagnosed Rx patients (p<0.001). The undiagnosed group had a higher proportion of males (58.1%). The majority of undiagnosed individuals (71.5%) reported some form of employment. Undiagnosed individuals had greater comorbidity burden (Charlson Comorbidity Index: 0.91 vs 0.55, p<0.001) than diagnosed Rx.

Undiagnosed individuals had worse mental health composite scores (34.73 vs 38.27, p<0.001) and physical composite scores (36.95 vs 40.42, p<0.001); differences exceeded minimally important difference for these measures. There was also greater overall work impairment (68.1% vs 35.4%, p<0.001) and activity impairment (53% vs 39.9%, p<0.001) compared with diagnosed Rx patients. Undiagnosed individuals had higher numbers of emergency room visits (1.34 vs 0.39, p<0.001), hospitalizations (1.13 vs. 0.27, p<0.001) than diagnosed Rx.

CONCLUSIONS: Undiagnosed psoriasis individuals had higher work impairment, lower HRQoL (both mental and physical), and incurred higher HCRU compared with diagnosed and prescription treated psoriasis patients in the EU4+UK. Improvements in diagnosis rates and treatment rates may help alleviate some of the burdens experienced by patients with psoriasis.