GPP Flares Linked to Increased Hospitalizations, Health Care Costs, Study Finds

Patients with generalized pustular psoriasis (GPP) in the US who experience flares face a significantly higher health care burden, according to new insights.1 Not only were patients with flares found to have nearly twice the hospitalization rate compared with those without, but pharmacy and total gross charges also increased with the number of flares, reaching an average of $57,674 and $52,940, respectively for patients with 2 or more flares.

Patients with generalized pustular psoriasis (GPP) in the US who experience flares face a significantly higher health care burden. | Image credit: ARTFULLY-79 - stock.adobe.com

These findings underscore the need for improved disease management strategies to reduce hospitalizations and associated health care costs.

This noninterventional cohort study is published in the Journal of Psoriasis and Psoriatic Arthritis.

“Although electronic health records (EHRs) and administrative claims databases can be useful for understanding the burden of GPP on the health care system, the rarity of GPP and lack of standard documentation for flares and disease severity measures makes it difficult assess factors that impact health care resource utilization,” wrote the researchers of the study. “As a result, few studies examining the impact of GPP flares and disease severity on health care resource utilization (HCRU) and associated charges have been published.”

The symptoms and severity of GPP vary with each flare for a particular patient, which can lead to emergency department (ED) visits or inpatient care.2 The cost burden of GPP has been found to be much higher than psoriasis vulgaris (PV), in which the 10-year mean costs of care in which GPP was the “most responsible diagnosis” (MRD) were $2393, compared with just $222 when PV was the MRD.

In the current study, the researchers aimed to quantify health care resource utilization (HCRU), pharmacy charges, and total charges among patients with GPP in outpatient and dermatology clinics in the US, according to documented flare status and underlying disease severity.1

The study analyzed electronic health record (EHR) data from January 2017 to January 2023. Patient-level data were sourced from 6 specialty dermatology networks within the OMNY Health real-world data platform, which included structured EHR fields, clinical measures of GPP severity, and unstructured clinical notes. Eligible patients had a confirmed GPP diagnosis, were at least 12 years old, and has clinical notes and claims data with at least 1-year of follow-up.

Of approximately 7.4 million patients in the dermatology EHR dataset, 335 met the study criteria, with 205 (61%) experiencing at least 1 GPP flare.

Flares were associated with increased hospitalizations (12.2% vs 6.9%), a higher mean (SD) number of hospitalizations (0.26 [0.93] vs 0.09 [0.36]), and greater hospitalization charges ($1207 vs $455). While fewer patients with flares visited the ED (22.9% vs 27.7%), they had more frequent visits (0.54 vs 0.45) and higher associated charges ($840 vs $769).

A direct correlation was observed between the number of flares and both pharmacy and total gross charges, with patients experiencing 2 or more flares incurring the highest costs ($57,674 in pharmacy charges and $52,940 in total gross charges). Those with moderate to severe disease at baseline had significantly higher mean pharmacy charges ($24,666 vs $5078) and total gross charges ($36,222 vs $10,042) over the follow-up period.

However, the researchers noted some limitations. First, the data were derived from US-based outpatient dermatology practices and may not be generalizable to patients in primary or nonspecialist settings. Additionally, prescription data reflected orders and administrations rather than actual medication adherence.

Despite these limitations, the researcher believe study underscores the substantial burden of GPP flares and highlights the need for proactive disease management to reduce HCRU and associated costs.

“Nonetheless, the results of this study highlight the importance of understanding GPP flares in terms of patient demographic and clinical characteristics and the increased patient and economic burden associated with number of flares and underlying disease severity,” wrote the researchers. “Managing GPP patients to prevent flares and treat emerging flares are important to reducing HCRU and associated charges.”

References

1. Noe MH, Lavasani L, Rasouliyan L, et al. Healthcare resource utilization among patients with generalized pustular psoriasis: The impact of flares and disease severity. J Psoriasis Psoriatic Arthritis. Published online January 25, 2025. doi:10.1177/24755303251317193

2. Kaltwasser J. Cost burden of GPP much higher than psoriasis vulgaris, study finds. AJMC. Published April 24, 2023. Accessed February 4, 2025. https://www.ajmc.com/view/cost-burden-of-gpp-much-higher-than-psoriasis-vulgaris-study-finds.