Healthcare resource utilization, healthcare costs and dose escalation in psoriasis patients initiated on ustekinumab versus adalimumab: a retrospective claim study

Abstract

Background: Adalimumab and ustekinumab are effective psoriasis treatments. This study compares healthcare resource utilization (HRU), costs and dose escalation and describes starting dose trends in ustekinumab versus adalimumab psoriasis patients.

Methods: Adult psoriasis patients initiating adalimumab/ustekinumab on/after 25 September 2009 were selected from a US claims database and classified into biologic-naïve and biologic-experienced samples.

Results: A total of 602 ustekinumab and 3470 adalimumab biologic-naïve and 1193 ustekinumab and 1467 adalimumab biologic-experienced patients were included. In both samples, ustekinumab patients had significantly more days with medical services (biologic naïve: IRR =1.14; biologic experienced: IRR =1.08) and higher average total costs by more than $14,000 annually. Ustekinumab users were 2.6 and 1.9 times more likely to have a dose escalation (increase ≥45 mg in ustekinumab; ≥40 mg in adalimumab) in biologic-naive and biologic-experienced patients, respectively. Between S2/2009 and S1/2012, the proportion of patient initiating on high dose (ustekinumab: >45 mg/28 days; adalimumab: >160 mg/28 days) increased substantially for ustekinumab patients (biologic naïve: +18.6 percentage points [PP]; biologic experienced: +29.9 PP) but remain stable for adalimumab patients (biologic naïve: −0.3 PP; biologic experienced: +2.3 PP).

Conclusion: Ustekinumab patients had more HRU, higher total costs and were more likely to have a dose escalation. The proportion of patients initiating ustekinumab high dose increased substantially between 2009 and 2012.

Keywords:

• Health expenditures
• medical care costs
• drug costs
• economics
• monoclonal antibody
• anti-inflammatory agent

Acknowledgements

We thank Ana Bozas and Dominick Latremouille-Viau, who contributed to the editing of the manuscript. Ana Bozas and Dominick Latremouille-Viau are employees of Analysis Group, Inc., which has received consultancy fees from AbbVie for this study.

Ethical research standards statement

Data used in this study are de-identified, comply with the patient confidentiality requirements of the Health Insurance Portability and Accountability Act (HIPAA), and are exempt from Institutional Review Board approval.

Disclosure statement

Design, study conduct and financial support for the study were provided by AbbVie; AbbVie participated in the interpretation of data, review and approval of the manuscript; all authors contributed to the development of the publication and maintained control over the final content. A Guérin and G Gauthier are employed by Analysis Group, Inc., which has received payment from AbbVie to assist with data analysis. M Sundaram is an employee of AbbVie and may own AbbVie stock or stock options. Dr. Wu received research funding from AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim, Coherus Biosciences, Dermira, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Regeneron, Sandoz and Sun Pharmaceutical Industries; he is a consultant for AbbVie, Amgen, Celgene, Dermira, Eli Lilly, Pfizer, Regeneron and Sun Pharmaceutical Industries.

Notes

1 A HR >1 indicates that ustekinumab users were more likely to have a dose escalation compared to adalimumab users.