Real-world treatment patterns and healthcare costs among biologic-naive patients initiating apremilast or biologics for the treatment of psoriasis

Wu, Jashin J.; Pelletier, Corey; Ung, Brian; Tian, Marc

doi:10.1080/13696998.2019.1571500

Cited by 19 publications

(21 citation statements)

References 11 publications

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“…Our findings are consistent with prior analyses among commercially insured, biologicnaive patients with psoriasis, which found similar treatment persistence rates and switch rates and significantly lower total healthcare costs at 12 months among patients initiating apremilast compared with those initiating a biologic [32,33]. To our knowledge, there are no similar studies in the literature conducted in patients with PsA who were treated with apremilast.…”

Section: Discussionsupporting

confidence: 90%

“…In recent claims-based analyses of data from biologic-naive patients initiating treatment with apremilast or a biologic for psoriasis, persistence rates for apremilast and biologics were similar and apremilast demonstrated a cost advantage (based on paid amounts of adjudicated claims) over biologics for patients who were persistent and for those who were not persistent (i.e., those who discontinued or switched from their index treatment) [ 32 ]. A similar study also found similar treatment persistence and switch rates and lower healthcare costs (including all adjudicated claims) among biologic-naive psoriasis patients receiving treatment with apremilast versus a biologic [ 33 ]. However, studies assessing treatment persistence or discontinuation rates may fail to adequately capture the true rate and costs associated with treatment switching.…”

Section: Introductionmentioning

confidence: 88%

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Treatment Switch Patterns and Healthcare Costs in Biologic-Naive Patients with Psoriatic Arthritis

Pelletier²,

Ung³

et al. 2020

Adv Ther

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Introduction: We compared treatment switch patterns and healthcare costs among biologicnaive patients with psoriatic arthritis (PsA) who initiated apremilast or biologics. Methods: A 1:2 propensity score match was used to adjust administrative claims data for adults initiating apremilast or biologics from January 1, 2014, to September 30, 2016, for possible selection bias. Patients had at least 12 months of pre-and post-index continuous enrollment in the Optum Clinformatics TM Data Mart database. Outcomes included switch frequency, days to switch, adherence on index treatment, and healthcare costs (total and per patient per month). Switch rate was defined as the proportion of patients who switched to a new treatment after initiation of the index Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11830302.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 88%

Treatment Switch Patterns and Healthcare Costs in Biologic-Naive Patients with Psoriatic Arthritis

Pelletier²,

Ung³

et al. 2020

Adv Ther

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“…Similarly, greater mean physician encounters were observed for patients indexing to oral immunotherapy in the joint cohort, showed that switching rates were similar among patients initiating oral apremilast versus biologics in those with PSO or PsA. 26,27 Our finding of greater switching within skin and joint and skin cohorts indicates that oral immunotherapy in general might not be as effective and/or tolerated as injectable immunotherapies in the treatment of these chronic conditions because switching medications is considered a potential proxy for lack of treatment effect. 43 Switching was also marginally greater for the joint cohort, although lacked statistical significance.…”

Section: ■■ Discussionmentioning

confidence: 88%

“…In a study by Machado et al (2018), results similar to this study were observed, wherein fewer patients with RA on TNFi or non-TNFi biologics switched medications relative to patients on oral tofacitinib. 28 In contrast, studies by Wu et al (2019) ■■ Results Of the 6,525 patients meeting the study eligibility criteria (Figure 1), 66% (n = 4,333) were classified with joint conditions, 19% (n = 1,216) with skin conditions, and 15% (n = 976) with joint and skin conditions. A majority of patients in each study cohort were indexed to an injectable agent: 89% (n = 3,875) for joint, 78% (n = 951) for skin, and 82% (n = 805) for joint and skin.…”

Section: ■■ Discussionmentioning

confidence: 99%

“…24,25 Although the efficacy of tofacitinib and apremilast has been demonstrated, data on effectiveness in real-world settings are minimal. [26][27][28] With easy administration and adherence/persistence akin to biologic immunotherapies, 26,27,29 oral therapies are receiving greater acceptance in clinical practice. However, there is a scarcity of evidence on how effectiveness of oral agents compares with injectable immunotherapies on various health care utilization and cost outcomes across different chronic inflammatory diseases.…”

Section: What This Study Addsmentioning

confidence: 99%

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Comparing Medical Utilization and Cost Outcomes in Oral Versus Injectable Immunotherapy Users with Chronic Inflammatory Joint and Skin Diseases

Bhattacharya

Herren

Poonawalla

et al. 2020

JMCP

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BACKGROUND: Rheumatoid arthritis (RA), psoriatic arthritis (PsA), and psoriasis (PSO) are immune-mediated systemic, chronic inflammatory conditions. Moderate to severe disease is treated with conventional disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, or leflunomide. If a patient does not respond to these firstline treatments, then tumor necrosis factor inhibitor (TNFi) or non-TNFi immunotherapy agents are administered via infusion, injection, or taken orally. Although the effectiveness of established infusion, injection, and newer oral therapies are known, the relative effectiveness among the routes of administration is not well understood.OBJECTIVE: To compare drug use, health care resource utilization, and costs among patients who are treatment-naive to oral immunotherapy and injectable biologic immunotherapy.METHODS: This retrospective observational study used claims data from a large U.S. health plan to identify new users of oral and injectable immunotherapy, diagnosed with a joint (RA or PsA), skin (PSO), or joint and skin condition from July 1, 2014, to June 30, 2017. The index date was the first claim for an oral or injectable medication. Medicaid, Medicare Advantage, and commercial plan patients aged 19-89 years with continuous enrollment 6 months before and 12 months after the index date were included in the study. Outcomes were adjusted using propensity score by inverse probability of treatment weighting. Treatment discontinuation, switching, health care resource utilization, and costs were measured during the post-index period. RESULTS: Oral versus injectable users with joint (n = 458 vs. 3,875), skin (n = 265 vs. 951), or joint and skin (n = 171 vs. 805) conditions were identified. For drug utilization outcomes, no differences in discontinuation rates were observed between oral and injectable groups for any of the cohorts. However, those in skin and joint and skin cohorts had higher rates of switching to other immunotherapies in patients initiated on orals compared with injectables. Health care resource utilization outcomes were mixed. While mean outpatient and physician office visits were significantly higher in oral compared with injectable groups across all 3 cohorts, no differences were observed for inpatient stays. Total costs (medical plus pharmacy) were lower for oral groups across all 3 cohorts. Pharmacy costs were lower for oral groups, but medical costs were higher for oral groups across all 3 cohorts. CONCLUSIONS: This is the first population-level study at a route-ofadministration level, which compared switching, health care resource utilization, and costs across several conditions. Switching drugs was more likely in the oral group, which may indicate lower effectiveness or tolerability of oral immunotherapies relative to injectables. Health care resource utilization was higher in the oral group, but total costs were lower, which was likely driven by the lower costs of oral drugs.

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Traditional Systemic Therapy II: Retinoids and Others

Ramachandran

Rosén

Koshelev³

et al. 2020

Advances in Psoriasis

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Real-world treatment patterns and healthcare costs among biologic-naive patients initiating apremilast or biologics for the treatment of psoriasis

Cited by 19 publications

References 11 publications

Treatment Switch Patterns and Healthcare Costs in Biologic-Naive Patients with Psoriatic Arthritis

Treatment Switch Patterns and Healthcare Costs in Biologic-Naive Patients with Psoriatic Arthritis

Comparing Medical Utilization and Cost Outcomes in Oral Versus Injectable Immunotherapy Users with Chronic Inflammatory Joint and Skin Diseases

Traditional Systemic Therapy II: Retinoids and Others

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