1 2 Cost - of - illness in patients with moderate to severe psoriasis : 3 a cross - sectional survey in Hungarian dermatological centres 4

9 Abstract 10 Background Despite the widespread availability of bio11 logical drugs in psoriasis, there is a shortage of disease 12 burden studies. 13 Objectives To assess the cost-of-illness and quality of 14 life of patients with moderate to severe psoriasis in 15 Hungary. 16 Methods Consecutive patients with Psoriasis Area and 17 Severity Index (PASI) [ 10 and Dermatology Life Quality 18 Index (DLQI) [ 10, or treated with traditional systemic 19 (TST) or biological systemic treatment (BST) were inclu20 ded. Demographic data, clinical characteristics, psoriasis 21 related medication, health care utilizations and employ22 ment status in the previous 12 months were recorded. 23 Costing was performed from the societal perspective 24 applying the human capital approach. Quality of life was 25 assessed using DLQI and EQ-5D measures. 26 Results Two-hundred patients were involved (females 27 32 %) with a mean age of 51 (SD 13) years, 103 (52 %) 28 patients were on BST. Mean PASI, DLQI and EQ-5D 29 scores were 8 (SD 10), 6 (SD 7) and 0.69 (SD 0.3), 30 respectively. The mean total cost was €9,254/patient/year 31 (SD 8,502) with direct costs accounting for 86 %. The 32 main cost driver was BST (mean €7,339/patient/year). 33 Total costs differed significantly across treatment sub34 groups, mean (SD): no systemic therapy €2,186 (4,165), 35 TST €2,388 (4,106) and BST €15,790 (6,016) (p \ 0,001). 36 Patients with BST had better PASI and DLQI scores 37 (p \ 0.01) than the other two subgroups. 38 Conclusions Patients with biological treatment have a 39 significantly better quality of life and higher total costs than 40 patients with or without traditional systemic treatment. Our 41 study is the largest in Europe and the first in the CEE 42 region that provides cost-of-illness data in psoriasis 43 involving patients with BST. 4