What Clinical Severity Assessments May Miss: The Importance of Self-Perceived Severity in Uncovering Burden of Illness Among Patients With Psoriasis

OBJECTIVES: Patient-perceived psoriasis severity may not correlate with clinical severity classification. This analysis examined the humanistic and economic burden of patients with psoriasis severity classified as mild (<3%) according to body surface area (BSA). Among those with mild BSA, those who self-reported their severity as moderate-to-severe (SR-ModSev) were compared with those who self-reported their severity as mild (SR-Mild).

METHODS: This analysis used the 2020 EU (France, Germany, Spain, Italy, UK) National Health and Wellness Survey data , an internet-based cross-sectional survey of adults. Socio-demographic, clinical, and patient-reported outcome (PRO) data between SR-ModSev and SR-Mild groups were compared using chi-square and ANOVA tests. PROs included EQ5D-5L, Work Productivity and Activity Impairment Questionnaire (WPAI), healthcare resource use (HCRU) and Patient Health Questionnaire (PHQ)-9 Scale.

RESULTS: In this mild BSA cohort, 21.5% were SR-ModSev (n=618) and 78.5% were SR-Mild (n=2,251). SR-ModSev vs. SR-Mild were younger (47 vs. 49 years, p<0.05) and a higher proportion were female (60% vs. 54.3%, p<0.05). SR-ModSev had lower EQ5D-5L scores compared with SR-Mild (0.71 vs 0.78, p<0.05). SR-ModSev vs. SR-Mild experienced greater work productivity loss (38.7% vs 26.5%, p<0.05) and activity impairment (39% vs 29.5%, p<0.05). A smaller proportion of SR-ModSev relative to SR-Mild had none-minimal depression based on PHQ-9 (38.8% vs. 48.9%, p<0.05). SR-ModSev had a higher number of dermatologist visits (0.39 vs 0.19, p<0.05), emergency room visits (0.65 vs 0.31, p<0.05), and hospitalizations (0.56 vs. 0.16, p<0.05).

CONCLUSIONS: Despite both groups’ psoriasis severity being clinically classified as mild using BSA, the SR-ModSev group had higher disease burden: worse quality of life, greater work productivity and activity impairment, higher presence of depression, and incurred higher HCRU compared with SR-Mild. These findings highlight the importance of the patients’ perspective and limitations of the traditional classification of the severity of psoriasis based on the categories of “mild, moderate and severe” from the BSA.