Review of an established UK home phototherapy service 1998-2011: improving access to a cost-effective treatment for chronic skin disease.

Type:Uv phototherapy Time:2014-11-18 16:03:32

Review of an established UK home phototherapy service 1998-2011: improving access to a cost-effective treatment for chronic

skin disease.

Cameron H1, Yule S2, Dawe RS2, Ibbotson SH2, Moseley H2, Ferguson J2.

Author information

Abstract

OBJECTIVES:

To review the Tayside home phototherapy service, including numbers of patients treated, diagnoses and outcomes, side-effects

and safety, cost-effectiveness and absolute costs. To consider why home or outpatient phototherapy is not available to all

patients who might benefit and how this could be addressed.

STUDY DESIGN:

Observational and cost analysis.

METHODS:

Analysis of the Tayside home phototherapy database 1998 and 2011, home phototherapy patient questionnaires, outcome data,

costs and a comparison with outpatient phototherapy. Review of literature and current national guidelines for phototherapy,

traditional systemic and biologic therapies for psoriasis.

RESULTS:

298 courses of home narrowband UVB (NB-UVB) phototherapy were undertaken by 212 patients between 1998 and 2011, five courses

in 1998 increasing to 36 in 2011. The main diagnoses treated were psoriasis (72%), atopic dermatitis (8%), and

desensitization of photodermatosis (7%). For psoriasis, 74.5% achieved clearance or minimal residual activity in a median of

30 exposures (range 10-60). The estimated costs to the hospital ranged from ��229 to ��314 per course (��307 to ��422 per

effective course for psoriasis), compared with ��114 for out-patient therapy (��149 per effective course for psoriasis). The

total cost to society (hospital and patient costs) is around ��410 per course, compared to an estimated ��550 for outpatient

therapy for this group of patients. Treatment was well tolerated, erythema rates were similar to outpatient therapy, there

were no complaints and the vast majority would choose home over outpatient phototherapy if required in the future.

CONCLUSIONS:

Hospital supervised home phototherapy appears as safe and effective as outpatient therapy and provides equality of access for

patients who cannot attend for outpatient therapy. These patients may otherwise be inadequately treated or given more costly

and higher risk systemic therapies, particularly for psoriasis. Commissioners and clinicians involved in dermatology services

should provide accessible phototherapy for all patients who might benefit, utilizing home phototherapy where outpatient

access is not possible.

KEYWORDS:

Chronic disease; Equality of access; Home phototherapy; Narrowband ultraviolet B; TL-01

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