Heterogeneity in the treatment of moderately severe scalp psoriasis in Scotland – results of a survey of Scottish health professionals

Abstract

Background:

Scalp psoriasis is a chronic recalcitrant condition. An aging literature for topical treatments used in clinical practice and no treatment guidelines means there is no current gold standard for its management in Scotland. There are no Scottish data on the resources and costs of treatment of the scalp psoriasis patient.

Objective:

Conduct a survey of Scottish healthcare professionals to understand how patients are typically managed to support the development of a model estimating the cost-effectiveness of a new treatment for moderately severe scalp psoriasis in Scotland.

Research design and methods:

Experts from primary and secondary care were invited to participate in an interview programme to collect information on the management of scalp psoriasis in Scotland. This was further informed by Scottish prescribing statistics. Simple descriptive statistics were performed.

Results:

Forty-three healthcare professionals (33 from primary care and ten in secondary care) completed the survey which illuminated national prescribing statistics. While an overall 72% response rate was achieved, representation from five of 14 Health Boards was not available. There was significant variation in stated patient pathways but some common themes. Most patients were treated initially with coal tar preparations and shampoos, then often progressing to topical potent corticosteroids. There was no consensus on the order patients might receive topicals thereafter although if referred for specialist review they would typically have been treated with three topicals in primary care first. Treatment in secondary care comprised application of topicals available in primary care or alternative preparations with nurse assistance to improve compliance. Phototherapy and systemic agents were not given to patients with scalp psoriasis alone. Study limitations are not considered to impact on the study observations.

Conclusions:

There was a large variety in first-, second- and third-line agents in primary care in scalp psoriasis although our interview programme and prescribing data confirmed which treatments were most frequently prescribed. Treatment heterogeneity reflects the limitations in current therapies, paucity of evidence-based effectiveness data and lack of clinical guidelines. Experts agreed ‘current standard practice’ in Scotland was best described as an average across five plausible treatment pathways.

Key words::

• Costs
• Heterogeneity
• Hospital referrals
• Resources
• Scalp psoriasis
• Treatment pathway

Transparency

Declaration of funding

This study was supported by LEO Pharma who funded Amygdala’s consulting services.

Declaration of financial/other relationships

J.S. and P.J. have disclosed that they are employees of LEO Pharma UK. D.S. has disclosed that he is a self employed General Practitioner partner working as an independent contractor to NHS Scotland at Banchory Group Practice and employed by NHS Grampian as a GP with Special Interest in Dermatology. J.B. and M.A. have disclosed that they are employees of Amygdala Ltd and have received funding from LEO Pharma.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgements

The authors thank all the primary and secondary care respondents who participated in the structured interview or questionnaire (respondents included Dr William Carr, Dr Keith Freeman, Dr Cathy Green, Dr Girish Gupta, Dr Colin Morton, Barbara Page and Dr John Ross) and all additional GPs who contributed to the question concerning use of and expected effectiveness of a non-fixed combination of calcipotriol scalp application and potent steroid.

Notes

* Xamiol is a registered trademark of LEO Pharma A/S, Ballerup, Denmark.

* Diprosone is a registered trademark of Schering-Plough Ltd.

† Etrivex is a registered trademark of Galderma Ltd.