OBJECTIVES: : To estimate the total costs of moderate to severe psoriasis patients in Spain. METHODS: : An observational study was conducted at 123 centers in Spain recruiting 1217 patients (60.8% males, mean age 45.1±13.9 years, 95.6% with active treatment) with moderate (60.8%) to severe (39.2%) psoriasis (VACAP study). Direct and indirect resource consumption during the study was collected for every patient using patient notebooks. Direct resource use consisted in inpatient hospitalization, surgeries, emergency room visits, consultations (primary and secondary care, nursery, other healthcare professionals and alternative medicine visits), laboratory and diagnostic tests, medication (prescription and non-prescription drugs paid by patients), and phototherapy sessions. Indirect costs included productivity losses (full or part-time), social assistance and out-of-pocket expenses paid directly by patients (travel costs, formal caregivers). Resource use unitary costs were obtained from e-Salud database. Four-month costs were extrapolated to annual costs (€, year 2009 values). RESULTS: Mean annual total cost per patient was €6881 (95% confidence interval [CI], €5365-€8370). Direct and indirect costs accounted for €6420 (95%CI, €5067-€7745) and €461 (95%CI, €299-€625) representing 93.3% and 6.7% of total estimated costs respectively. The most important categories of direct costs were prescription medication (€3667, 95%CI, €2954-€4381, 53.3% of direct costs), phototherapy sessions (€1405, 95%CI, €1144-€1666, 20.4%), consultations (€517, 95%CI, €434-€567, 7.5%) and hospital day visits (€436, 95%CI, €294-€578, 6.3%) The most significant indirect costs were loss of productivity (€357, 95%CI, €216-€500, 77.5% of indirect costs) and travel costs (€85, 95%CI, €76-€95, 18.5%). CONCLUSIONS: : In Spain, mean annual cost per patient with moderate to severe psoriasis represents €6881, of which 93% were direct costs and 7% indirect costs.