Abstract:BackgroundBiological therapies (BTs) including infliximab (IFX), adalimumab (ADL), secukinumab (SCK) and ustekinumab (UST) are approved in Japan for the treatment of psoriasis. Although the persistence rates and medical costs of BTs treatment have been investigated in multiple foreign studies in recent years, few such studies have been conducted in Japan and the differences between patients who adhered to treatment and those who did not have not been reported. This study is aimed at investigating the persisten… Show more
“…Because the treatment choice scenarios were prepared assuming biologic treatments for moderate to severe psoriasis, it might have been difficult for some participants to personally relate to the selection based on their past experience. However, the study showed similar trends consistent with previous studies presenting greater preference for dosing convenience, higher prescription rate of treatments with longer dosing frequencies in females, more concern about severe adverse event occurrence in the elderly patients, and lower importance of co‐payment or cost in patients currently treated with biologics . These results may partially support the external validity of the study.…”
Psoriasis is a chronic autoimmune disease affecting skin which may also manifest in nails and joints. Several biologic treatments have been approved in Japan for psoriasis. Each biologic has a different profile for efficacy and safety, including different dosing regimens and co‐payment considerations which may complicate treatment decisions made by patients and physicians during short consultations. Elucidating patient preference is expected to contribute to shared decision‐making between patients and physicians to optimize treatment satisfaction and outcomes. However, the number of studies investigating this in Japan is very limited. The study used a discrete choice experiment methodology to elicit patient preferences for hypothetical options in an experimental framework. Participants were asked to choose their preferred treatment option from two hypothetical choices, defined by different levels of six attributes (i.e. early onset of efficacy, long‐term efficacy, sustained efficacy after drug withdrawal, dosing convenience, co‐payment and risk of serious infection). The survey included 16 treatment choice scenarios and was completed by 395 participants. Across all participants, the attribute regarded as most important was sustained efficacy after drug withdrawal, followed by dosing convenience, co‐payment, long‐term efficacy, early onset of efficacy and risk of serious infection. The study found that patients prefer treatments which have durable efficacy and lower treatment burden characterized as fewer injection frequency and lower co‐payment. These results may be helpful to understand patient preference for biologic treatments used for psoriasis in Japan and contribute to shared decision‐making between patients and physicians to improve patient satisfaction and treatment outcomes.
“…Because the treatment choice scenarios were prepared assuming biologic treatments for moderate to severe psoriasis, it might have been difficult for some participants to personally relate to the selection based on their past experience. However, the study showed similar trends consistent with previous studies presenting greater preference for dosing convenience, higher prescription rate of treatments with longer dosing frequencies in females, more concern about severe adverse event occurrence in the elderly patients, and lower importance of co‐payment or cost in patients currently treated with biologics . These results may partially support the external validity of the study.…”
Psoriasis is a chronic autoimmune disease affecting skin which may also manifest in nails and joints. Several biologic treatments have been approved in Japan for psoriasis. Each biologic has a different profile for efficacy and safety, including different dosing regimens and co‐payment considerations which may complicate treatment decisions made by patients and physicians during short consultations. Elucidating patient preference is expected to contribute to shared decision‐making between patients and physicians to optimize treatment satisfaction and outcomes. However, the number of studies investigating this in Japan is very limited. The study used a discrete choice experiment methodology to elicit patient preferences for hypothetical options in an experimental framework. Participants were asked to choose their preferred treatment option from two hypothetical choices, defined by different levels of six attributes (i.e. early onset of efficacy, long‐term efficacy, sustained efficacy after drug withdrawal, dosing convenience, co‐payment and risk of serious infection). The survey included 16 treatment choice scenarios and was completed by 395 participants. Across all participants, the attribute regarded as most important was sustained efficacy after drug withdrawal, followed by dosing convenience, co‐payment, long‐term efficacy, early onset of efficacy and risk of serious infection. The study found that patients prefer treatments which have durable efficacy and lower treatment burden characterized as fewer injection frequency and lower co‐payment. These results may be helpful to understand patient preference for biologic treatments used for psoriasis in Japan and contribute to shared decision‐making between patients and physicians to improve patient satisfaction and treatment outcomes.
“…1a). This definition of persistence was consistent with that employed in other claims data-based studies of RA [10, 26] and other indications [27, 28]. Fig.…”
ObjectiveThe study assessed persistence rates of biological disease-modifying antirheumatic drugs (bDMARDs) for the treatment of rheumatoid arthritis in Japan and compared resource utilization and treatment costs between persistence and non-persistence groups.MethodsData were extracted from a Japanese claims database between 2009 and 2015. bDMARD-naïve patients were identified and included in the final analysis. Survival analysis was used to estimate 1-year persistence rates for current bDMARDs. Propensity score matching was applied to control for potential treatment selection bias. Resource utilization and healthcare costs were calculated 1 year before and after initiation of bDMARDs and compared between persistence and non-persistence groups.ResultsA total of 6153 bDMARD-naïve patients were identified and the overall 1-year persistence rate was 85% (95% CI 84–86). Overall, 1-year outpatient visits increased from 10 at baseline to 16 after bDMARD treatment, while the number of hospital admissions declined from 3.3 to 1.6. The non-persistence group had a larger increase in outpatient visits after bDMARD initiation compared with the persistence group (8–16 vs. 10–16, respectively) and a smaller decrease in hospital admissions (3.1–1.9 vs. 3.5–1.4, respectively). Persistence was associated with a reduction in total healthcare costs of US$760.ConclusionsJapanese bDMARD-naïve patients with RA have a high persistence rate with those treatments. The reduction in medication costs in non-persistent patients is offset by higher hospitalization costs, making non-persistence more expensive.Electronic supplementary materialThe online version of this article (10.1007/s40801-018-0139-8) contains supplementary material, which is available to authorized users.
“…[8][9][10] Among claims-based studies, some use a permissible gap of 150 days for ustekinumab (which has a 12-week maintenance dosing interval) and 90 days for all other drugs (which are dispensed every 4 weeks during the maintenance period). 11,12 However, this method is not responsive to the differences between induction and maintenance dosing or to dose escalation. Other studies completely exclude the induction period from their analysis, then apply a permissible gap of 28 days for etanercept, 56 days for adalimumab, and 126 days for ustekinumab on the basis of expert opinion.…”
Purpose
Studies of medication persistence in plaque psoriasis have shown inconsistent results, likely due to differing definitions of nonpersistence and of the permissible gap between refills. Also, medication persistence information for two recently approved drugs, apremilast and ixekizumab, is limited.
Methods
We use the Truven Health MarketScan claims database to assess persistence for six drugs: adalimumab, apremilast, etanercept, ixekizumab, secukinumab, and ustekinumab. We define the permissible gap in three ways: 150 days for ustekinumab and 90 days for all other drugs (150/90 model); 120 days for all drugs (120 model); and twice the days' supply for all drugs (days' supply model). To estimate unadjusted persistence, we use Kaplan‐Meier curves, and a proportional hazards model to estimate the adjusted risk of non‐persistence.
Results
Ustekinumab is most sensitive to changes in the definition of permissible gap, likely because of its longer maintenance dosing interval. Among targeted drug‐experienced patients using ustekinumab, median persistence is 358 days (95% confidence interval: 343‐371) in the 150/90 model and 189 days (179‐199) in the days' supply model. Among targeted drug‐experienced patients, median persistence in the days' supply model is longest for ixekizumab and secukinumab at 252 (217‐301) and 222 (210‐244) days, respectively. We also find that adjusted risk of nonpersistence increases by approximately 1% per year at treatment start.
Conclusion
The definition of permissible gap meaningfully changes both absolute and ordinal estimates of medication persistence. Each definition has unique limitations, which should be considered when interpreting persistence data.
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