Psoriasis Treatment: Home Phototherapy Most Cost-Effective, Study Finds

For individuals navigating the challenges of moderate to severe plaque psoriasis, a familiar hurdle often arises: accessing effective treatment that fits both their health needs and their financial realities. Whereas biologic therapies frequently demonstrate significant improvements in quality of life, a recent simulation study published in JAMA Dermatology highlights a potentially overlooked and surprisingly cost-effective option – home phototherapy. The research suggests that despite its proven efficacy and lower costs, home phototherapy remains significantly underutilized, raising questions about insurance coverage and treatment convenience.

Balancing Efficacy, Cost, and Access

The study, led by Edward L. Kong, PhD, of Harvard Medical School and Elizabeth A. Buzney, MD, of Brigham and Women’s Hospital, utilized a simulation model to compare the tradeoffs between three psoriasis treatment approaches. Researchers assessed outcomes for bimekizumab (Bimzelx, UCB) – representing biologic therapies – narrowband UVB phototherapy, and a step-therapy program. This step-therapy approach required 16 weeks of phototherapy before initiating a 16-week trial of the biologic if a PASI 90 response (a 90% improvement in psoriasis area and severity index) wasn’t achieved. The simulation encompassed 500,000 adult patients over a one-year period.

“There was a question of mutual interest for us: How does the cost benefit [of phototherapy] shake out with the availability of recent biologic therapies?” Kong told Healio. “Previously, we only had TNF-alpha inhibitors for psoriasis, and now, the insurance landscape has changed. We wanted to reexamine this question, comparing phototherapy and biologics.”

Simulation Details and Findings

The simulation parameters were based on data from randomized clinical trials, cohort studies, and economic analyses conducted between 2013 and 2024. Key outcomes measured included PASI reductions at 32 weeks, quality-adjusted life-years (QALYs) – monetized at $100,000 per QALY – and total treatment costs for payers. The mean baseline PASI value for patients in the simulation was 20.2.

At 32 weeks, the mean PASI reductions were notably different: 91.6% for bimekizumab, 71.1% for phototherapy, and 95.2% for the step-therapy regimen. However, the cost implications were substantial. Mean first-year QALY gains were 0.24 for biologics, 0.18 for phototherapy, and 0.23 for step therapy. Mean annual total costs reached $84,034 for bimekizumab, compared to $14,760 for office phototherapy and a remarkably low $6,222 for home phototherapy. Out-of-pocket costs followed a similar pattern: $2,000 for biologics, $5,004 for office phototherapy, and $1,450 for home phototherapy.

The net willingness to pay among payers was highest for home phototherapy ($11,694) and lowest for biologics (–$59,926). Patients also expressed a positive willingness to pay across all regimens, with biologics leading at $22,107, followed by home phototherapy ($16,466) and office phototherapy ($12,912).

The Role of Step Therapy

The study also examined the impact of a step-therapy approach. Researchers found that 58.9% of patients in the step-therapy group did not achieve a PASI 90 response with phototherapy and subsequently switched to the biologic. Of those who switched, 92.2% continued with the biologic, while 7.8% reverted back to phototherapy.

Why Isn’t Home Phototherapy More Widely Used?

Despite the clear cost advantages, home phototherapy remains underutilized. The researchers attribute this to a combination of factors, including insurance coverage policies and the inconvenience associated with in-office treatment. Earlier cost analyses, they note, predate the approval of newer biologic therapies and the growing evidence supporting the effectiveness of home phototherapy. A 2024 study demonstrated that home phototherapy can be as effective as traditional in-office UVB treatment for psoriasis.

“There was a paper published in 2009 that looked at how insurance affects whether people chose phototherapy, but no one has looked at it since then,” Kong explained. “We need to think about phototherapy as an option. We have a whole toolkit, not just biologics.”

Implications for Coverage and Access

The authors emphasize that biologics, office-based phototherapy, and home phototherapy are often reimbursed under separate benefit structures, creating misaligned incentives for both patients and payers. They suggest that aligning cost-sharing rules within a unified coverage framework could improve patient access, equity, and system sustainability.

Joel M. Gelfand, MD, MSCE, FAAD, Healio Dermatology Chief Medical Editor, echoes this sentiment, stating that this analysis should serve as a call to action for payers. He advocates for increased reimbursement for office phototherapy to encourage wider availability and elimination of copayments for patients. For home phototherapy, he suggests expanding coverage without prior authorization or cost-sharing, and covering the necessary counseling and training provided by dermatologists and their staff. Read more at Healio.

The study underscores the importance of considering the full spectrum of treatment options for psoriasis, recognizing that the most expensive therapy isn’t always the most effective or accessible for all patients. As Kong and Buzney conclude, phototherapy deserves renewed consideration as a safe, effective, and potentially transformative treatment modality for individuals living with this chronic skin condition. Further research into optimal implementation strategies and advocacy for improved insurance coverage are crucial steps toward maximizing the benefits of home phototherapy for a wider population. The National Psoriasis Foundation offers resources and support for patients navigating treatment options and insurance challenges: https://www.psoriasis.org/. For more information on phototherapy, the American Academy of Dermatology provides a comprehensive overview: https://www.aad.org/public/diseases/psoriasis/treatment/phototherapy.

Disclosures: Gelfand reports receiving consultant fees from AbbVie, Artax, Bristol Myers Squibb, Boehringer Ingelheim, Celldex, FIDE, GlaxoSmithKline, Inmagene, Leo, Lilly, Janssen Biologics, Moonlake, Neuroderm, Novartis, Oruka, Pfizer, UCB and Veolia North America; receiving research grants from Amgen, Bristol Myers Squibb and Pfizer; receiving payment for continuing medical education work related to psoriasis that was supported indirectly by pharmaceutical sponsors; co-holding a patent for resiquimod for treatment of cutaneous T-cell lymphoma; receiving honoraria for serving as deputy editor of the Journal of Investigative Dermatology and receiving honoraria from the Society for Investigative Dermatology; serving as Chief Medical Editor for Healio Dermatology and receiving honoraria; and serving on the board of directors for the International Psoriasis Counsil and the Medical Dermatology Society, receiving no honoraria.