People with psoriasis suffer from patches of red, flaky skin that can appear on any part of the body. Psoriasis affects the quality of life of people with the condition and needs good treatments that work well. Importantly, it is known that people with psoriasis also have other medical conditions affecting the heart, the kidneys, and the liver, and these conditions means that some people need to access many treatments and frequently use the National Health Service (NHS). This study will describe the types of healthcare treatments and services and associated costs to the NHS for people who have psoriasis. Understanding the use of healthcare for people with psoriasis is important because it allows people developing new services and treatments to see where they should be directed and improved. Our aim is to describe the patient journeys for people with psoriasis alone and with other conditions so we can see where better care and treatments may be needed. We also aim to examine patterns of health events, treatments and referrals to other healthcare services that occur prior to the diagnosis of psoriasis that may help to identify opportunities for earlier diagnosis. We will compare these health events with those occurring over the same time in individuals without psoriasis. This will enable us to decide on events most likely to indicate onset of psoriasis and important earlier signs leading up to its onset.
The first aim of the study will be to identify, and quantify, the use of healthcare resources (including: medicines; GP-visits, out-patient visits, A&E visits, hospitalisation) and associated costs to the NHS for the experienced patient journey of people with psoriasis and selected co-morbidities. The study will use a retrospective analysis of cohort data that links CPRD (clinical practice research datalink) with HES (hospital episode statistics) and ONS (Office National Statistics) mortality data and patient-level IMD (index of multiple deprivation). A cohort study comprising adult patients identified using a Read coded diagnosis of psoriasis between 01/04/2007 and 31/12/2018, and eligible for linkage to A&E, outpatient and inpatient HES and ONS records will be matched (on age, gender and practice) with unaffected comparison patients. Generalised linear models will be used to compare differences in resource use between groups. Selection will be restricted to patients registered with a contributing practice for at least one year and follow-up will end when the patient either dies, transfers out of the practice, last data collection, the end of the study period. The primary outcome will be use of healthcare resources, and key confounders will include presence of co-morbidities, BMI, smoking status and patient-level deprivation. The second aim will examine the healthcare contacts prior to the diagnosis of psoriasis using a case-control study design in order to explore potential opportunities for earlier diagnosis. The incidence of other specific health diagnoses, symptoms, referrals and treatments leading up to diagnosis of psoriasis will be determined and incidence risk ratios calculated using regression analysis for each year prior to diagnosis from all contacts through primary and secondary care sources of individuals with and without psoriasis.
Primary care resource use (total and by region)
Secondary care resource use (total and by region)
Prevalence of co-morbidities
Incidence of co-morbidities, referrals, and specific treatments
Darren Ashcroft - Chief Investigator - University of Manchester
Darren Ashcroft - Corresponding Applicant - University of Manchester
Alexander Thompson - Collaborator - University of Manchester
Cathy Morgan - Collaborator - University of Manchester
Christopher Griffiths - Collaborator - University of Manchester
Claire Reid - Collaborator - University of Manchester
Federica Ciamponi - Collaborator - University of Manchester
Georgios Gkountouras - Collaborator - University of Manchester
Katherine Payne - Collaborator - University of Manchester
Maha Abo-Tabik - Collaborator - University of Manchester
Peslie Ng’ambi - Collaborator - University of Manchester
Rosa Parisi - Collaborator - University of Manchester
Sarah Willis - Collaborator - University of Manchester
Sean Gavan - Collaborator - University of Manchester
Thomas Allen - Collaborator - University of Manchester
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation