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April 2, 1982

Cost-effectiveness of PUVA Therapy: Further Considerations

JAMA. 1982;247(13):1808. doi:10.1001/jama.1982.03320380014008

To the Editor.—  Previous studies have established that methoxsalen (PUVA [methoxsalen plus ultraviolet light]) is an effective mode of treatment for psoriasis.1 In a recent article in The Journal, Stern et al (1981;245:1913) have demonstrated that this outpatient procedure is cost-effective for the treatment of psoriasis in view of the need for hospitalization for many such patients. This view was supported in an editorial by Henry H. Roenigk, MD, in the same issue (1981; 245:1941), who advocated Food and Drug Administration approval of labeling to recommend this procedure.However, the authors did not include in their equations the expenditures related to an already established risk of the treatment. Stern et al have demonstrated a significant increase in the skin cancer formation induced by this modality during a four-year period.2,3 These cancers will require biopsies, histological examinations, and definitive therapy (eg, surgery, ionizing radiation) for complete eradication. The costs