{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T04:30:40Z","timestamp":1793507440696,"version":"4.5.0"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec id=\"ab-doi250077-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Phototherapy remains an effective and cost-efficient treatment for psoriasis, yet its use is constrained by coverage policies and the inconvenience of in-office treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi250077-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the efficacy, quality-of-life gains, and cost-effectiveness of biologics, phototherapy, and step-therapy strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi250077-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>Simulation modeling study in patients with moderate to severe plaque psoriasis (Psoriasis Area and Severity Index [PASI] \u226512) using published estimates of efficacy, costs, and mappings between PASI score and quality-adjusted life-years (QALYs) from 2013 through 2025. Analysis was conducted between July 1 and November 21, 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi250077-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>One year of treatment with a representative biologic (bimekizumab), narrowband UV-B phototherapy (home or office) or a step-therapy regimen where patients initiated phototherapy for 16 weeks and switched to biologics if PASI90 (an improvement in PASI score of \u226590%) was not achieved, continuing the more effective therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi250077-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Main outcomes were PASI reductions at 32 weeks, QALYs monetized as $100\u202f000 per QALY, and total treatment costs to payers. Secondary outcomes included out-of-pocket costs and net willingness to pay, defined as monetized QALYs minus costs. Sensitivity analyses considered risankizumab and adalimumab.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi250077-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 500 000 simulated adult patients, the mean (SD) baseline PASI value was 20.2 (7.5). Mean (SD) PASI reductions were 91.6% (20.1%) for biologics, 71.1% (30.3%) for phototherapy, and 95.2% (10.8%) for the step-therapy regimen. Mean (SD) reductions were most variable for phototherapy (71.1% [30.3%]) and least variable for step therapy (95.2% [10.8%]). Mean (SD) QALY gains were 0.24 (0.08) for biologics, 0.18 (0.09) for phototherapy, and 0.23 (0.06) for step therapy. Mean (SD) monetized gains were $24\u202f107 ($7916) for biologics, $17\u202f916 ($9421) for phototherapy, and $22\u202f560 ($6324) for step therapy. Mean (SD) annual total costs were $84\u202f034 (0) for biologics, $14\u202f760 (0) for office phototherapy, and $6222 (0) for home phototherapy. Mean (SD) out-of-pocket costs were $2000 (0) for biologics, $5004 ($9241) for office phototherapy, and $1450 (0) for home phototherapy. From the payer perspective, mean (SD) net willingness to pay was highest for home phototherapy ($11\u202f694 [$9421]) and lowest for biologics (\u2013$59\u202f926 [$7916]). For patients, the mean (SD) willingness to pay was positive across all regimens and highest for biologics ($22\u202f107 [$7916]), followed by home phototherapy ($16\u202f466 [$9421]) and office phototherapy ($12\u202f912 [$13\u202f192]). Among biologics, payers preferred adalimumab, whereas patients preferred bimekizumab.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi250077-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this study, biologics provided the largest quality-of-life gains, while step-therapy strategies achieved similar benefits with less variability and lower system costs. Phototherapy remained cost-effective for payers. Divergent incentives\u2014payers favoring phototherapy and patients favoring biologics\u2014underscore the need to align coverage, including reduced cost sharing for home phototherapy, to improve access and system sustainability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamadermatol.2025.6193","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T16:30:40Z","timestamp":1772037040000},"page":"395","source":"Crossref","is-referenced-by-count":2,"title":["Benefits and Costs of Biologics and Phototherapy in Psoriasis Treatment"],"prefix":"10.1001","volume":"162","author":[{"given":"Edward L.","family":"Kong","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Buzney","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"19","key":"doi250077r1","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1001\/jama.2020.4006","article-title":"Pathophysiology, clinical presentation, and treatment of psoriasis: a review.","volume":"323","author":"Armstrong","year":"2020","journal-title":"JAMA"},{"issue":"3 Pt 1","key":"doi250077r2","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/S0190-9622(99)70112-X","article-title":"Psoriasis causes as much disability as other major medical diseases.","volume":"41","author":"Rapp","year":"1999","journal-title":"J Am Acad Dermatol"},{"issue":"2","key":"doi250077r3","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1016\/j.jaad.2020.04.095","article-title":"Role of phototherapy in the era of biologics.","volume":"84","author":"Torres","year":"2021","journal-title":"J Am Acad Dermatol"},{"issue":"1","key":"doi250077r4","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/phpp.12088","article-title":"Phototherapy, psoriasis, and the age of biologics.","volume":"30","author":"Richard","year":"2014","journal-title":"Photodermatol Photoimmunol Photomed"},{"issue":"3","key":"doi250077r5","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.det.2024.02.002","article-title":"Phototherapy for psoriasis in the age of biologics.","volume":"42","author":"Sandoval","year":"2024","journal-title":"Dermatol Clin"},{"issue":"8","key":"doi250077r7","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1111\/ijd.16677","article-title":"Systematic review and estimated cost-efficacy of biologics compared with narrowband ultraviolet B light for the treatment of moderate to severe psoriasis and atopic dermatitis.","volume":"62","author":"McCoy","year":"2023","journal-title":"Int J Dermatol"},{"issue":"8","key":"doi250077r8","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1080\/09546634.2018.1466022","article-title":"Comparison of the cost-effectiveness of biologic drugs used for moderate-to-severe psoriasis treatment in the United States.","volume":"29","author":"Wu","year":"2018","journal-title":"J Dermatolog Treat"},{"issue":"4","key":"doi250077r10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5070\/D30WZ4H31B","article-title":"Paradoxical effects of cost reduction measures in managed care systems for treatment of severe psoriasis.","volume":"15","author":"Yentzer","year":"2009","journal-title":"Dermatol Online J"},{"issue":"2","key":"doi250077r11","doi-asserted-by":"publisher","first-page":"859","DOI":"10.3982\/ECTA17635","article-title":"Are medical care prices still declining? 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