Analysis of drug utilization and health care resource consumption in patients with psoriasis and psoriatic arthritis before and after treatment with biological therapies

Abstract

ObjectivesTo describe the therapeutic pathways of patients with psoriasis (PSO) and psoriatic arthritis (PsA) before and after treatment with biological therapies in a real-world setting and to determine the relative consumption of health care resources.DesignRetrospective observational study.SettingReal-life clinical setting in 5 Italian local health units.ParticipantsA total of 351 male and female patients with at least 1 prescription for a biological drug from January 1, 2010 to December 31, 2013; patients with concomitant rheumatoid arthritis, ankylosing spondylitis, or Crohn’s disease were excluded.ResultsThe major health care cost (excluding drug costs) was represented by hospitalizations, mainly related to PSO /PsA-associated disorders and cardiometabolic disorders. Use of conventional drugs among biologics-naïve patients reached 50% in PSO and 80% in PsA; their use decreased following initiation of biological therapy. After the start of biological treatment, the incidence of hospitalization decreased both for PSO (from 12.3% to 3.2% in day hospital regimen and from 2.4% to 0.4% for conventional admission) and for PsA (from 11.1% to 8.1% and from 10.1% to 3.0%, respectively). Mean annual costs for hospitalization before biological treatment were €217 and €537 for PSO and PsA, respectively, while mean annual cost for concomitant drugs slightly increased after biologics initiation: from €249.8 to €269.4 for PSO and from €331.8 to €346.9 for PsA. The major consumption of health care resources occurred in the quarter preceding the beginning of biological treatment.ConclusionThe consumption of health resources is mostly related to hospitalization, seems to peak during the quarter before the beginning of biologics therapies, and subsequently decreases after biologics initiation. Further studies should focus on prescription scheme and economic burden of PSO and PsA in Italy to help optimize health care resources and potentiate services for patients.

Are Patients with Psoriasis and Psoriatic Arthritis Undertreated? A Population-Based Study from Southern Italy

“…A higher proportion of the PsA patients (32.2%) were treated with bDMARDs (mostly with etanercept and adalimumab) compared to the PsO patients (4.9%), in which ustekinumab was the most frequently used bDMARD. Compared with a previous drug utilization study conducted in Italian PsO and PsA patients [ 31 ], etanercept, adalimumab and ustekinumab were the three most frequently reported bDMARDs as the first biological treatment; however, the proportion of PsO and PsA patients treated with these compounds was higher, except for ustekinumab in PsA, compared to our study. Furthermore, Marcianò et al documented, using the claims database, an underutilization of bDMARDs in PsO/PsA patients from another general population of Southern Italy in the years 2010–2014 [ 32 , 33 ].…”

Epidemiology of psoriasis among the elderly population and volume of specialized medical care provided to patients with psoriasis in the Russian Federation in 2010–2019

“…Основные затраты при оказании медицинской помощи по поводу псориаза связаны с ее оказанием в стационарах как дневных, так и круглосуточных [21,22]. Однако исследования показателей госпитализации пациентов с псориазом в период после появления биологических генно-инженерных препаратов ограничены, а их результаты противоречивы.…”

“…Однако исследования показателей госпитализации пациентов с псориазом в период после появления биологических генно-инженерных препаратов ограничены, а их результаты противоречивы. Некоторые авторы констатируют снижение потребности в госпитализации как по поводу псориаза, так и по поводу ассоциированных с псориазом состояний после появления биологических генно-инженерных препаратов [21]. Другие исследователи указывают на отсутствие изменений и тенденцию к росту количества госпитализаций по поводу обострений псориаза после появления биологических генно-инженерных препаратов и предполагают, что это может быть связано как с ростом заболеваемости, так и с осведомленностью пациентов о появлении нового эффективного лекарственного лечения и повышением вследствие этого обращаемости за медицинской помощью [23].…”

A Belgian consensus on the definition of a treat‐to‐target outcome set in psoriasis management

“…As a systemic inflammatory disease, psoriasis is plagued by comorbidities, including psoriatic arthritis and cardiovascular diseases that may reduce life expectancy . Interestingly, recently Mehta's group showed that treatment with biologics could reduce coronary inflammation and healthcare resource consumption . Furthermore, duration of skin lesions has been linked to the risk of PsA, hypothesizing that early and aggressive intervention may prevent the development of PsA, and perhaps other comorbidities.…”

“…22 Interestingly, recently Mehta's group showed that treatment with biologics could reduce coronary inflammation and healthcare resource consumption. 23,24 Furthermore, duration of skin lesions has been linked to the risk of PsA, hypothesizing that early and aggressive intervention may prevent the development of PsA, 25 and perhaps other comorbidities. Moreover, we should also pay attention to the Cumulative Life Course Impairment that patients with psoriasis experience, including a heavy burden on their social and mental well-being over several years living with the disease.…”