Inequality in access to biological treatments for psoriasis due to age

[Fred]

This study suggests the older you get the less likely you are to get a Bio treatment for psoriasis.

Quote:

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Background:
Inequality in healthcare has been identified in many contexts. To the best of our knowledge, this is the first study investigating age inequality in the form of prescription patterns of biologics in psoriasis care.

Objectives:
To determine whether patients with psoriasis have equal opportunities to receive biological medications as they age. If patients did not receive equal treatment, a subsequent objective was to determine the magnitude of the disparity.

Methods:
A cohort of biologic-naive patients with psoriasis was analysed using Cox proportional hazards models to measure the impact of each additional year of life on the likelihood of initiating biological treatment, after controlling for sex, body mass index, comorbidities, disease activity and educational level. A supporting analysis used a nonparametric graphical method to study the proportion of patients initiating biological treatment as age increased, after controlling for the same covariates.

Results:
The Cox proportional hazards model resulted in hazard ratios of a 1-year increase in age of 0·96–0·97 depending on calendar-year stratification, which implies that an increase in age of 30 years corresponds to a reduced likelihood of initiating biological treatment by 61·3–67·6%. The estimated proportion of patients initiating biological medication always decreased as age increased, at a statistically significant level.

Conclusions:
Patients with psoriasis have fewer opportunities to access biological medications as they age. This result was shown to be applicable at all stages in a patient's life course and was not only restricted to the elderly, although it implies greater disparities as the age difference between patients increases. These results show that inequality in access to biological treatments due to age is prevalent in clinical practice today. Further research is needed to investigate the extent to which this result is influenced by patient preferences.

Source: onlinelibrary.wiley.com

Funded by:
Swedish Board of Health and Welfare
Swedish Association of Local Authorities and Regions
Västerbotten County Council

[jiml]

I can't think of a good reason to discriminate against older people being prescribed biologicals, in fact I can think of more reasons to discriminate against younger sufferers, purely on the grounds of cost. If you can put off prescribing expensive biological drugs until the sufferer is older it would reduce the cost of treatment saving health services a great deal of money

p.s. I'm not suggesting that this should happen I'm just thinking its more logical,

[Fred]

I can't think of a good reason to discriminate against older people being prescribed biologicals, in fact I can think of more reasons to discriminate against younger sufferers, purely on the grounds of cost. If you can put off prescribing expensive biological drugs until the sufferer is older it would reduce the cost of treatment saving health services a great deal of money

p.s. I'm not suggesting that this should happen I'm just thinking its more logical,

I'm with you Jim. Personally I would say hold off on the Bio's if you're young and let your healthier body fight the problem as it will give you something later on to use, we all know psoriasis is here to stay and older people have paid their dues so why not give them a good quality of life.

Psoriatic arthritis gets worse as we age so to me it makes sense to give it to older patients as there bodies are not so likely to be able to fight it.

p.s Unlike you I am suggesting it should happen, I have paid my dues and as I get older I would like to continue to get the benefits.

[JohnB]

I would love to be able to say it beggars belief, but I'm afraid I can't. I've seen first hand how the older you get the less you seem to be entitled to and the more you have to rant and rave to get some action. 
I'm guessing this is not just UK specific?

[jiml]

Indeed I don't think it would apply if you were already on them Fred, and it looks to me as if I will not get the offer as I'm past my use by date

Hopefully I won't need to change drugs and can stay on my inexpensive one  

[Fred]

I'm guessing this is not just UK specific?

It was a Swedish study, but it's an early view so without paying for the whole study I'm not sure if it was Country, Europe, or World. related.

Indeed I don't think it would apply if you were already on them Fred,

No sorry Jim I wasn't thinking I would lose my treatment. I was talking about health care in general. I expect to get good treatment because I've paid in and hardly took anything out when I was younger.

[Grizzly Bear]

Swedish study ?

I once saw a Swedish film year's ago. Most interesting it was.

Sweden is jolly chilly though.

[mataribot]

I am sure it's just as bad here. Good luck getting a bio with government insurance. I bet you have a better chance at winning the loto.

[D Foster]

I am not sure that this study would apply to wholly UK as certainly in my area age does not seem to be a factor whether or not you get bio's ,I know a few patients of my age (68) who are on it. When I was put on it ,which must be around 3 years ago now , the criteria was related to how bad you were and what your current treatment was achieving plus side effects of your current treatment. Maybe in other countries that have an insurance payment factor within their system a commercial aspect is added in the mix.
I would say without any shadow of doubt that there are prejudices against older people for many treatments within the NHS and these definitely vary from area to area throughout UK.
I will say one thing about the demonology department in my area it's done by BUPA on a contract to the NHS and the difference is really measurable ,compared to the NHS it's so much better and well organised through Spire. My self injection of the Stelara is also supplied by BUPA Home Healthcare which is going to have a change of ownership to Celesio , the owner of Lloyds Pharmacy so I hope they keep up their quality care that I have experienced from BUPA.