Home vs In-Office Phototherapy for Patients with Vitiligo: Comparison of Time, Cost, Efficacy, and Safety
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BACKGROUND: The use of home phototherapy has been a research topic for multiple skin diseases, including vitiligo, psoriasis, and eczema. Home phototherapy requires a large upfront cost for the equipment needed at the patient's home. However, lower long- term costs and greater convenience could make it an ideal option for patients with full-time employment, inability to pay for in-office treatments or other daily responsibilities preventing travel for in-office treatments. HYPOTHESIS: Home Phototherapy will reduce the socioeconomic burden and long-term out-of-pocket costs for vitiligo patients compared to in-office phototherapy. SPECIFIC AIMSs: The objective of this study is to evaluate and compare the treatment time and treatment costs of in-office phototherapy to that of home phototherapy in the treatment of vitiligo. METHODS: 18 patients with vitiligo were identified as receiving either home phototherapy or in-office phototherapy based on chart review. Nine patients receiving phototherapy were then matched with 9 patients who were receiving in-office phototherapy. The study participants were categorized into two groups: participants receiving in-office phototherapy and participants receiving home phototherapy. Patients were matched on ethnicity, vitiligo severity, and amount of time treated with phototherapy. The patients in each group were asked to record time to complete phototherapy sessions for one week. The cost of in office phototherapy treatment, insurance reimbursement, and patient out of pocket costs were obtained from financial records. OUTCOMES: The home phototherapy unit we used for the study, the Panasol 3D, costs USD 4590. The projected mean cost over one year for home phototherapy was USD 4,590, while the mean cost for in-office phototherapy was USD 21,271. In 3 months the home phototherapy unit pays for itself compared to in office phototherapy. Regarding the time to complete phototherapy, 9 pairs of patients, matched for distance from the dermatology clinic, skin type and duration of phototherapy treatment. We found that the mean time to complete home phototherapy was 22 minutes while mean time to complete in office treatments was 86 minutes (p = .0004). The mean percent improvement for the home group was 43%, while the mean percent improvement for the in-office group was 45%, (p = 0.8073). Both groups showed significant improvement of their vitiligo Home phototherapy reduces the socioeconomic burden and long-term out-of-pocket costs for vitiligo.