Belgian Study Maps True Cost Drivers in Psoriasis Care

A recent single-center study published in BMC Health Services Research by Roman et al used Time-Driven Activity-Based Costing (TD-ABC) to quantify the true costs of psoriasis care and identify drivers of variability at both the consultation and annual treatment levels. Conducted in Belgium, this research offers valuable insights into how European health care systems can optimize resource use within dermatology departments. Among 127 patients with mild to moderate psoriasis, the mean consultation cost was €55 (range €25–€110). New patients generated 40% higher costs than returning ones, primarily due to longer interaction times with nurses and physicians.¹

Cost variability was significantly influenced by patient status (new vs. returning), therapy switches, nurse experience, and patient personality traits, particularly perceived disease burden and engagement with treatment. Mean annual treatment costs also diverged sharply by therapy type: €325 for topical, €1,353 for systemic, and €11,920 for biologic treatments. This underscores how therapeutic choice shapes overall expenditure.²

Clinical and Economic Relevance

For dermatology departments operating within a value-based health care (VBHC) framework, these data highlight that variability in consultation costs is driven as much by interpersonal and behavioral factors as by clinical complexity. Understanding these drivers can inform resource allocation, workflow optimization, and the design of bundled payment models, a reimbursement approach increasingly used for chronic disease management.

While biological therapies remain the dominant cost driver, the study emphasizes that variability in staff time and patient engagement also contributes meaningfully to care costs, factors that are often overlooked in standard financial accounting systems. The findings position TD-ABC as a promising tool for mapping where variability occurs and for revealing opportunities to improve efficiency without compromising care quality.

Methodological Approach

The research applied TD-ABC, a costing methodology that assigns a per-minute cost to each clinical resource (nurse, physician, facilities) based on practical capacity. Consultations were directly observed, and durations for each activity were measured by clinical staff using stopwatches. Additional data, including demographics, comorbidities, Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), and Hospital Anxiety and Depression Scales (HADS), were retrieved from medical records.

Regression analyses examined how independent variables affected nurse, physician, and total consultation costs. New patients, those with a high disease burden, and those undergoing therapy changes consistently required longer and more resource-intensive encounters. Nurse experience also impacted costs, suggesting that workflow distribution among staff could influence efficiency.

Implications for Practice

Clinically, these findings point to tangible opportunities for improving dermatology service design. Stratifying appointment types, such as scheduling extended intake sessions for new or high-burden patients and shorter follow-ups for stable cases, could enhance both time efficiency and patient satisfaction. Similarly, integrating patient personality assessments and engagement surveys into intake protocols might help tailor communication strategies, optimizing clinician time.

From a systems perspective, the study underscores the importance of transparent, patient-level cost data in developing equitable bundled payments for chronic dermatologic conditions. Current bundled payment frameworks have been successfully implemented for diseases like diabetes and renal failure but remain underexplored in dermatology. The psoriasis cost data presented here provide a starting point for defining episode-of-care bundles that reflect realistic clinical complexity and resource utilization.

Limitations and Future Directions

The study’s single-center design and relatively small sample limit generalizability. Additionally, the analysis excluded indirect and comorbidity-related costs—factors particularly relevant in psoriasis, where conditions such as psoriatic arthritis and depression significantly affect total care costs. The authors recommend expanding TD-ABC studies across institutions and linking cost data with clinical outcomes to further refine value-based care delivery models.

Conclusion

This investigation provides one of the most granular examinations of psoriasis care costs to date. It demonstrates that patient-level variability, rooted in status, treatment engagement, and therapy dynamics, significantly shapes provider-incurred costs. Beyond its economic insights, the study advocates for using cost transparency as a lever to align clinical decision-making, operational design, and reimbursement policy.

For clinicians, the takeaway is clear: improving efficiency in chronic dermatologic care requires not only controlling drug expenditures but also understanding the nuanced human and organizational factors that drive consultation costs. Integrating TD-ABC into departmental management could represent a pragmatic step toward sustainable, value-based psoriasis care.

References

1. Roman E, Roodhooft F, Lambert J, Deprez E, Cardoen B. What drives patient cost variability in psoriasis care: a single centre study. BMC Health Serv Res. 2025;25(1):1343. Published 2025 Oct 9. doi:10.1186/s12913-025-13426-w
2. Rome BN, Han J, Mooney H, Kesselheim AS. Use and cost of first-line biologic medications to treat plaque psoriasis in the US. JAMA Dermatol. 2025;161(6):622-628. doi:10.1001/jamadermatol.2025.0669