Determining patient value profiles in psoriasis.
outcomes
psoriasis
value
Journal
Experimental dermatology
ISSN: 1600-0625
Titre abrégé: Exp Dermatol
Pays: Denmark
ID NLM: 9301549
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
revised:
05
07
2023
received:
20
04
2023
accepted:
28
07
2023
medline:
12
10
2023
pubmed:
11
8
2023
entrez:
11
8
2023
Statut:
ppublish
Résumé
Healthcare professionals (HCPs) should strive to create the maximum value for their patients in which value is defined as the patient-relevant health outcomes achieved per costs made. However, currently it remains difficult to determine which outcomes matter to an individual psoriasis patient. To define outcome profiles, or so called 'patient value profiles', within a cohort of psoriasis patients that can be translated to daily practice to increase value for the individual patient. Hierarchical clustering on principal components (HCPC) was used to identify groups of patients sharing the same profile within an outcome ranking exercise. Once the clusters were defined, their characterization was provided based on a V-test. In a final step, a multi-class decision tree (MDT) based on relevant socio-demographic and clinical variables was built to allocate patients to a cluster. In the ranking exercise 120 patients participated. The median age was 50.0 (IQR 25.0) years and 36.7% were female. Median PASI score was 2.4 (IQR 5.2) and median duration of psoriasis was 17.0 (IQR 20.0) years. Primary treatment varied from topicals to biologicals. We found three distinct patient value profiles in this cohort (QoL, cost and treatment). A MDT was built which had an accuracy of 64%. We found three distinct patient value profiles in a cohort of psoriasis patients and patients can be easily assigned to one of these profiles based on a MDT. HCPs can use these profiles to steer psoriasis management accordingly allowing for a more goal-orientated approach.
Sections du résumé
BACKGROUND
Healthcare professionals (HCPs) should strive to create the maximum value for their patients in which value is defined as the patient-relevant health outcomes achieved per costs made. However, currently it remains difficult to determine which outcomes matter to an individual psoriasis patient.
OBJECTIVE
To define outcome profiles, or so called 'patient value profiles', within a cohort of psoriasis patients that can be translated to daily practice to increase value for the individual patient.
METHODS
Hierarchical clustering on principal components (HCPC) was used to identify groups of patients sharing the same profile within an outcome ranking exercise. Once the clusters were defined, their characterization was provided based on a V-test. In a final step, a multi-class decision tree (MDT) based on relevant socio-demographic and clinical variables was built to allocate patients to a cluster.
RESULTS
In the ranking exercise 120 patients participated. The median age was 50.0 (IQR 25.0) years and 36.7% were female. Median PASI score was 2.4 (IQR 5.2) and median duration of psoriasis was 17.0 (IQR 20.0) years. Primary treatment varied from topicals to biologicals. We found three distinct patient value profiles in this cohort (QoL, cost and treatment). A MDT was built which had an accuracy of 64%.
CONCLUSION
We found three distinct patient value profiles in a cohort of psoriasis patients and patients can be easily assigned to one of these profiles based on a MDT. HCPs can use these profiles to steer psoriasis management accordingly allowing for a more goal-orientated approach.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1815-1822Informations de copyright
© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Porter ME, Teisberg EO. Redefining Health Care: Creating Value-Based Competition on Results. Harvard Business School Press; 2006.
Porter ME. What is value in health care? N Engl J Med. 2010;363(26):2477-2481. doi:10.1056/NEJMP1011024
Damiani G, Bragazzi NL, Karimkhani Aksut C, et al. The global, regional, and national burden of psoriasis: results and insights from the global burden of disease 2019 study. Front Med (Lausanne). 2021;8:743180. doi:10.3389/fmed.2021.743180
de Korte J, Sprangers MAG, Mombers FMC, Bos JD. Quality of life in patients with psoriasis: a systematic literature review. J Investig Dermatol Symp Proc. 2004;9(2):140-147. doi:10.1046/j.1087-0024.2003.09110.x
Takeshita J, Grewal S, Langan SM, et al. Psoriasis and comorbid diseases: epidemiology. J Am Acad Dermatol. 2017;76(3):377-390. doi:10.1016/j.jaad.2016.07.064
Hilhorst N, Deprez E, Pauwels N, Grine L, Lambert J, Hoorens I. Patient-relevant outcomes in psoriasis: a systematic review. JAMA Dermatol. 2022;158(7):806-811. doi:10.1001/JAMADERMATOL.2022.1756
Hilhorst NT, Deprez E, Balak DMW, et al. Initiating value-based healthcare in psoriasis: proposing a value-based outcome set for daily clinical practice. J Eur Acad Dermatol. 2023;16:528-539. doi:10.1111/JDV.18696
Maul JT, Navarini AA, Sommer R, et al. Gender and age significantly determine patient needs and treatment goals in psoriasis-a lesson for practice. J Eur Acad Dermatol Venereol. 2019;33(4):700-708. doi:10.1111/jdv.15324
Alcusky M, Lee S, Lau G, et al. Dermatologist and patient preferences in choosing treatments for moderate to severe psoriasis. Dermatol Ther (Heidelb). 2017;7(4):463-483. doi:10.1007/s13555-017-0205-2
DeCoster E, Alves de Medeiros A, Bostoen J, et al. A multileveled approach in psoriasis assessment and follow-up: a proposal for a tailored guide for the dermatological practice. J Dermatolog Treat. 2016;27(4):298-310. doi:10.3109/09546634.2015.1117566
Lambert J, Alves De Medeiros AK, van Reempts A, et al. The implementation of a structured specialized consultation for psoriasis management. Acta Clin Belg. 2021;76(6):421-426. doi:10.1080/17843286.2020.1750747
Husson F, Josse J, Pagès J. Principal Component Methods-Hierarchical Clustering-Partitional Clustering: why Would we Need to Choose for Visualizing Data?; 2010. Accessed March 2, 2023. http://www.sthda.com/english/upload/hcpc_husson_josse.pdf
R Core Team. R: a language and environment for statistical computing. R Foundation for Statistical Computing. 2023; https://www.R-project.org/
Breiman L, Friedman JH, Olshen RA, Stone CJ. Classification and regression trees. Routledge. 2017. doi:10.1201/9781315139470
Spielmann L, Nespola B, Séverac F, et al. Anti-Ku syndrome with elevated CK and anti-Ku syndrome with anti-dsDNA are two distinct entities with different outcomes. Ann Rheum Dis. 2019;78(8):1101-1106. doi:10.1136/annrheumdis-2018-214439
Maugeri A, Barchitta M, Basile G, Agodi A. Applying a hierarchical clustering on principal components approach to identify different patterns of the SARS-CoV-2 epidemic across Italian regions. Sci Rep. 2021;11(1):7082. doi:10.1038/s41598-021-86703-3
Groenewoud AS, Westert GP, Kremer JAM. Value based competition in health care's ethical drawbacks and the need for a values-driven approach. BMC Health Serv Res. 2019;19(1):256. doi:10.1186/S12913-019-4081-6
Mold J, Blake G, Becker L. Goal-oriented medical care. Fam Med. 1991;23(1):46-51.
Reuben DB, Tinetti ME. Goal-oriented patient care-an alternative health outcomes paradigm. N Engl J Med. 2012;366(9):777-779. doi:10.1056/NEJMp1113631
Schuttner L, Hockett Sherlock S, Simons CE, et al. My goals are not their goals: barriers and facilitators to delivery of patient-centered care for patients with multimorbidity. J Gen Intern Med. 2022;37(16):4189-4196. doi:10.1007/s11606-022-07533-1
Secrest AM, Matinrazm A, Ferris LK. Efficacy, safety, and out-of-pocket costs are the most important factors to patients in choosing a psoriasis therapy. J Clin Aesthet Dermatol. 2014;7(12):30-33.
van Cranenburgh OD, de Korte J, Sprangers MAG, de Rie MA, Smets EMA. Satisfaction with treatment among patients with psoriasis: a web-based survey study. Br J Dermatol. 2013;169(2):398-405. doi:10.1111/bjd.12372
Schmieder A, Schaarschmidt ML, Umar N, et al. Comorbidities significantly impact patients' preferences for psoriasis treatments. J Am Acad Dermatol. 2012;67(3):363-372. doi:10.1016/j.jaad.2011.08.023
Egeberg A, Thyssen JP. Factors associated with patient-reported importance of skin clearance among adults with psoriasis and atopic dermatitis. J Am Acad Dermatol. 2019;81(4):943-949. doi:10.1016/j.jaad.2019.06.018