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. 2025 Mar 28:15:105-116.
doi: 10.2147/PTT.S513878. eCollection 2025.

Analysis of the Reduction in the Duration of Sick Leave for 32,512 Psoriasis Patients Following the Integration of Targeted Therapies for Psoriatic Disease into the Brazilian Healthcare System: a Retrospective Cohort Study

Luiza Ferreira Vieira D'Almeida  1   2 , Gleison Vieira Duarte  3 , Marcos Paulo Godinho  2 , Louise Habka Cariello  1 , George Jó Bezerra Sousa  4 , Ciro Martins Gomes  1   5
Affiliations

Analysis of the Reduction in the Duration of Sick Leave for 32,512 Psoriasis Patients Following the Integration of Targeted Therapies for Psoriatic Disease into the Brazilian Healthcare System: a Retrospective Cohort Study

Luiza Ferreira Vieira D'Almeida et al. Psoriasis (Auckl). .

Abstract

Purpose: The Brazilian Unified Health System is an interesting model for international healthcare innovation analysis. Covering over 200 million people, this system stands out as one of the largest purchasers of healthcare technologies worldwide. Our goal in this study was to evaluate how targeted therapies reduce the duration of sick leave for psoriasis patients.

Patients and methods: We conducted a retrospective cohort study within the Brazilian National Institute of Social Security. The primary outcome was the return to work (cessation of sick leave) of patients with psoriasis. Factors such as age, sex, and access to targeted therapies were evaluated using a Cox proportional hazards model.

Results: Over the 25-year period from 1998 to 2023, 32,512 benefits were granted for psoriasis, totalling an expenditure of $577,478,002.15. Public access to psoriatic arthritis (PsA)-targeted therapies decreased the average minimum wage granted to psoriasis patients on sick leave by 22%, and public access to psoriasis-targeted therapies reduced the average wage by 7%. The availability of these therapies was associated with earlier cessation of sick leave in our proportional hazards model (targeted therapies for PsA: hazard ratio (HR) = 1.90, 95% confidence interval (CI) = 1.82-2.00; targeted therapies for psoriasis: HR = 1.63, 95% CI = 1.54-1.70).

Conclusion: This study highlights a remarkable reduction in costs and sick leave duration due to the implementation of therapies for psoriatic disease by the Brazilian Unified Health System, which underscores the importance of considering detailed indirect cost data when evaluating new health technologies for large populations.

Keywords: arthritis; costs and cost analysis; health care costs; health expenditures; psoriasis; psoriatic.

Plain language summary

Psoriasis is a chronic inflammatory disease affecting more than 60 million people worldwide. The disease is known to affect genetically predisposed individuals after an environmental trigger, sparking a relentless cycle of skin and systemic inflammation. The Brazilian Unified Health System offers an interesting case study for analysing the financial implications of cutting-edge healthcare technologies. Serving over 200 million diverse individuals, it is one of the world’s largest single buyers of healthcare technologies. In the CLEAR and FIXTURE trials, compared with ustekinumab and etanercept, secukinumab not only demonstrated superior efficacy but also significantly reduced work impairment for patients and the associated indirect costs of psoriasis from weeks 16 through 52 in the United Kingdom. Although controlled clinical trials have illustrated the positive impacts of effective therapies for psoriasis, there is a considerable gap in real-world data. Our study examines the impact of targeted therapies on reducing the duration of sick leave for psoriasis patients, leveraging extensive big data analysis from the Brazilian National Institute of Social Security system. Our findings revealed a significant reduction in costs and sick leave durations owing to the implementation of these therapies for psoriatic disease. This study underscores a remarkable reduction in costs and sick leave duration due to the implementation of therapies for psoriatic disease by the Brazilian Unified Health System. This finding highlights the importance of considering detailed indirect cost data when evaluating new health technologies for large populations.

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Conflict of interest statement

Prof. Ciro Martins Gomes is a consultant, lecturer and/or researcher for Boehringer-Ingelheim, Janssen, Novartis and AbbVie. Prof Gleison Duarte is a consultant, lecturer and/or researcher for Boehringer-Ingelheim, Pfizer, Leo Pharma, Amgen, UCB, Sanofi Genzyme, Janssen, Novartis and AbbVie. Luiza Ferreira Vieira d’Almeida is a lecturer for Novartis and AbbVie. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Consecutive maps showing that there was an increase in the number of Brazilian municipalities with beneficiaries until 2013, where 868 municipalities had at least one person receiving aid. From 2013 onwards, this number decreased, with 435 municipalities with beneficiaries in 2023. Maps generated by QGIS.org (2024). QGIS Geographic Information System. Open Source Geospatial Foundation Project. http://qgis.org.
Figure 2
Figure 2
A forest plot showing the results of the generalised linear model (GLM) with the log link function and gamma family. The results were exponentiated and represented as average ratios (95% confidence intervals). Public access to PsA-targeted therapies decreased the average minimum wage granted by 22% (average ratio (AR) = 0.78; 95% CI: 0.77–0·80), and public access to psoriasis-targeted therapies reduced the average wage by 7% (AR = 0.93; 95% CI: 0.91–0.96). Legend: PsA = psoriatic arthritis.
Figure 3
Figure 3
The survival curve shows that psoriasis patients who received social benefits during the period when targeted therapies were available for PsA exhibited a notably faster return to work. A positive association was observed between the availability of targeted therapies for PsA and reduced sick leave duration in the proportional hazards model. Legend: PsA = psoriatic arthritis. ***P < 0.001(Supplementary Data 1).
Figure 4
Figure 4
The survival curve revealed that psoriasis patients who received social benefits during the period when effective targeted therapies were available for psoriasis exhibited a notably faster return to work. A positive association was observed between the availability of targeted therapies for psoriasis and reduced sick leave duration in the proportional hazards model. *P < 0.05; ***P < 0.001(Supplementary Data 2).
Figure 5
Figure 5
The survival curve revealed a slightly shorter sick leave duration for psoriasis patients with access to PsA-targeted therapies than for patients with access to psoriasis-targeted effective therapies. Age and male sex were associated with longer sick leave durations. Legend: PsA = psoriatic arthritis. **P < 0.01; ***P < 0.001(Supplementary Data 3).
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