The Cost Burden of Psoriasis
为什么治疗如此昂贵，并降低成本
Cliff Crumpton, a总部位于佛罗里达州旅行渠道，HGTV，历史频道和其他网络的合同现场生产商尝试了天然的药膏和处方霜和紫外线疗法。他得到了可的松的射击。克鲁姆普顿（Crumpton）还为自己，妻子和他的刚出生的婴儿每月支付2,000美元的健康保险。这位34岁的猜测自2008年被诊断出患有牛皮癣以来，他的牛皮癣仍然存在。
The Cost Burden of Psoriasis
Crumpton isn’t alone. According to a systematic review published inJAMA皮肤病学那patients with psoriasis could spend up to $8,000 per year治疗他们的疾病。审查发现，牛皮癣的总成本负担在2013年在美国为1,120亿美元。医学经济学杂志那found thatpeople with psoriatic disease spent 450 percent more on pharmacy costsin their lifetimes than the control.
Why is treatment so expensive, and what can we do to get a handle on costs?
To keep his psoriasis–and his need for expensive medications–in check, Crumpton has monitored his stress levels and adjusted his diet to include more抗炎食品那probiotics, and teas like kombucha and yerba mate.
“人们在看我的冰箱时笑了，他们就像，‘这是什么？’”克鲁姆普顿在接受HealthCentral的电话采访中说。
Don't Supersize Me: Diet as a Means to Reduce Psoriasis Costs
饮食is perhaps the clearest way to cut the cost burden of psoriasis and potentially prevent the disease from worsening. A recent report, conducted in France and published inJAMA皮肤病学，对饮食习惯进行了3500人的牛皮癣的调查。那些坚持地中海饮食–one rich in healthy fats, fruit, vegetables, lean meats and whole grains–experienced less-severe disease progression.
“This finding supports the hypothesis that the Mediterranean diet may slow the progression of psoriasis,” write the study authors. “If these findings are confirmed, adherence to a Mediterranean diet should be integrated into the routine management of moderate to severe psoriasis.”
牛皮癣的治疗为什么如此昂贵，我们该怎么做才能处理成本？
从局部药物中挤出钱
There are other ways to cut costs with psoriasis, mainly by extending the lifetime oftopical medications。皮肤科医生建议将局部用按摩到皮肤中，以更深入地穿透皮肤屏障。许多患有牛皮癣的人也使用包裹方法：覆盖带有保鲜膜的治疗区域以捕获药物治疗并防止摩擦。
But for some, including Crumpton, topicals don’t work for long. Cortisone shots clear up most of his psoriasis, which covers 30 to 40 percent of his body.
“我必须问[my dermatologist]为此，”克鲁姆普顿说。“她不喜欢这样做。她会给我讲座；我了解这会使我的骨骼变得虚弱。那是我的，这样我就可以参加工作会议，没有人认为我正在吸毒或其他东西。”
Crumpton’s dermatologist prescribed methotrexate — a low-dose chemotherapy drug used to treat psoriasis and psoriatic arthritis — but she advised him not to take it, and he hasn’t. She did not think it was the right medication for him but she wanted to get around insurers’ prescription guidelines, also known as step therapy, so she could treat Crumpton’s psoriasis with biologic medications.
步骤疗法改革
美国东岸,牛皮癣患者在大多数州,are required by insurers to try lesser-expensive medications before they’re covered for pricy but highly affective biologics, which can cost insurers $40,000 per month. This process is called step therapy, and psoriasis advocates are working to reform it.
国家牛皮癣基金会政府关系和倡导副总裁帕特里克·斯通（Patrick Stone）表示，银屑病疾病的阶级治疗比其他疾病要高得多。纽约，德克萨斯州，爱荷华州，印第安纳州和伊利诺伊州都通过了步骤疗法改革。NPF正在游说包括马萨诸塞州在内的其他州的立法者，当患者被其保险公司拒绝承保范围时，提供了更清晰的上诉程序。
“We hear arguments based on cost and they come from insurers themselves and aren’t grounded in truth,” says Stone in a telephone interview with HealthCentral, adding that step therapy can be more expensive in the long run if patients try everything before they’re approved for the right drug. “Insurers should not be dictating how medicine is conducted. That’s up to the doctors working in the system.”
需要：修复健康保险系统的一种方法
在开了甲氨蝶呤之后，克鲁姆普顿的皮肤科医生为他开了生物药物斯泰拉拉（乌斯泰拉（Ustekinumab）），但他的保险公司佛罗里达蓝色拒绝了报道。克鲁姆普顿（Crumpton）曾三次上诉，并就他的选择咨询了律师。
他说：“这是一个非常有缺陷的系统。”“我觉得这些快餐保险公司只是在赚钱，他们并不总是支持客户。”
自从他的报道否认以来，克鲁姆普顿（Crumpton）已上Twitter与#operationNewhealth标签分享他的故事。他说他不确定如何修复该系统，但他希望其他人知道他们并不孤单。
他说：“它必须改变，这不仅仅是在牛皮癣上停下来。”“这就是#operationNewhealth的全部目标。我觉得我必须谈论它。”
要了解有关#operationNewhealth的更多信息，请在Twitter @soflodad上关注Cliff Crumpton。有关NPF的Step Therapy计划的更多信息，请访问Steptherapy.com。
