Real-World Experience With Apremilast in the Treatment of Adults With Moderate to Severe Plaque Psoriasis in Québec: A Claims-Based Analysis of Drug Utilization and Healthcare Resource Utilization

Abstract

Background In Québec, targeted biologic therapies for moderate to severe plaque psoriasis are restricted to patients who have not responded to phototherapy or conventional systemic treatment, primarily due to high drug costs. Apremilast, an oral treatment for plaque psoriasis, was added to the Québec provincial health insurance plan (Régie de l’assurance maladie du Québec; RAMQ) formulary in 2015, making this the only province in Canada with public drug plan reimbursement for apremilast. Objectives The aim of this study is to describe patients’ characteristics, treatment patterns, healthcare resource utilization (HCRU), and associated costs and to measure real-world budget impact of using apremilast before biologics in plaque psoriasis. Methods This study was performed using RAMQ drug claims and medical services data. Patients diagnosed with psoriasis between January 2015 and December 2017 were identified. Medical services and prescription claims were categorized as all-cause and psoriasis-related. Using RAMQ database estimates, a 3-year budget impact analysis was developed comparing treatment cost with and without the addition of apremilast to the formulary. Results In all, 540 patients were identified (apremilast: n = 92; biologics: n = 448). Comorbidity burden and treatment persistence and adherence were comparable between apremilast and biologic users. The year following the index date, all-cause HCRU was lower for apremilast versus biologic users (CAN$19 763 vs CAN$28 025; P < .01), mainly driven by drug cost. Using apremilast before biologics resulted in an estimated RAMQ net savings of CAN$49 290 (2015), CAN$746 856 (2016), and CAN$1 216 512 (2017), and a total savings of CAN$2 012 658 since apremilast’s addition to the formulary. Conclusion Adding apremilast to the drug formulary of other Canadian provinces could result in significant healthcare savings.

Apremilast and biologics: Characteristics of patients treated with apremilast before, during, or after a biological treatment

“…[4][5][6] They also found a high percentage of patients who had received prior systemic treatment. However, the proportion of patients who had received prior biological therapy was higher in our series (39%) than those reported in other apremilast real-life series (0%-19.4%), [4][5][6][7][8][9][10] probably due to the inclusion criteria of our study.…”

National reimbursement databases: Use and limitations for rheumatologic studies

“…Similarly to the SNDS, RAMQ makes it possible to perform medico-economic analyses [24], to increase knowledge on a given disease, such as RA [25,26], to describe trends in treatments persistence [27,28], or to identify the risk of deleterious outcomes related to specific drugs, such as the risk of fracture with antidepressants [29] or the risk of cardiovascular or gastrointestinal events with non-steroidal antiinflammatory drugs (NSAID) [30]. Furthermore, the design of this database enables original studies to better understand the healthcare system, to evaluate the impact of a health policy, or to assess the compliance to recommendations and guidelines.…”