Treatment patterns and healthcare costs among patients with psoriasis initiating apremilast or biologics: a retrospective claims database cohort analysis

Abstract

Objective

This study aimed to compare treatment patterns and healthcare costs for patients with psoriasis who initiate apremilast, tumor necrosis factor inhibitor, or interleukin inhibitor.

Methods

This retrospective cohort study used Optum Clinformatics^® Data Mart to identify propensity score–matched patients initiating apremilast, tumor necrosis factor inhibitors, or interleukin inhibitors, with 12-month baseline and 24-month follow-up data. Switch, discontinuation, persistence, healthcare resource utilization, and total healthcare costs were assessed.

Results

Twenty-four-month switch rates were highest for tumor necrosis factor inhibitors (32%), followed by apremilast (21%) then interleukin inhibitors (14%). Mean (SD) per-patient-per-month costs for switchers were lowest for apremilast ($4213 [$2304]), higher for tumor necrosis factor inhibitors ($5274 [$2280]), and highest for interleukin inhibitors ($5539 [$2296]; p < .001), primarily attributable to pharmacy costs: $3466 (apremilast), $4432 (tumor necrosis factor inhibitor), and $4721 (interleukin inhibitor).

Limitations

Psoriasis severity is absent from claims data; cost outcomes may be influenced by more severe psoriasis being more costly.

Conclusion

Switching psoriasis treatment is common and increases over time. Apremilast initiators had lower switch rates and costs compared with tumor necrosis factor inhibitors, despite lower effectiveness reported in previous studies, perhaps indicating patient preference for oral treatment. Additional oral options may be desirable for this population.

Keywords:

• Healthcare resource utilization
• interleukin inhibitor
• persistence
• tumor necrosis factor inhibitor

Acknowledgments

Professional medical writing and editorial assistance were provided by Nicole Boyer, MPH, PhD, of Peloton Advantage, LLC, an OPEN Health company, and funded by Bristol Myers Squibb.

Disclosure statement

J. J. W. is a former and/or current investigator, consultant, or speaker for AbbVie, Almirall, Amgen, Arcutis, Aristea Therapeutics, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Dermavant, DermTech, Dr. Reddy’s Laboratories, Eli Lilly, EPI Health, Galderma, Janssen, LEO Pharma, Mindera Health, Novartis, Pfizer, Regeneron, Samsung Bioepis, Sanofi Genzyme, Solius, Sun Pharmaceutical, UCB, and Zerigo Health. C. W. W., D. D., S. K., J. Z., M. S., V. P., and L.S. are employees of and shareholders in Bristol Myers Squibb. G. J. and M. M. are employees of Mu Sigma, which has received consulting fees from Bristol Myers Squibb.

Data availability statement

Data for these analyses were made available to the authors through third-party license from Optum Clinformatics^® Data Mart, a commercial data provider in the United States. As such, the authors cannot make these data publicly available due to a data use agreement. Other researchers can access these data by purchasing a license through Optum Clinformatics^® Data Mart. Inclusion criteria specified in the Methods section would allow other researchers to identify the same cohort of patients used for these analyses. Interested parties may see https://www.optum.com/business/life-sciences/real-world-data/claims-data.html for more information on Optum Clinformatics^® Data Mart.

Additional information

Funding

This work was supported by Bristol Myers Squibb.