Healthcare resource utilization and costs among psoriasis patients treated with biologics, overall and by disease severity

Figures & data

Table 1. Demographic characteristics for the biologic cohort, overall and stratified by disease severity.

	Biologic cohort, All		Biologic cohort, with recorded disease severity		Biologic cohort, Mild disease severity		Biologic cohort, Moderate disease severity		Biologic cohort, Severe disease severity
Demographic characteristics^a	(n = 2,130)		(n = 447)		(n = 282)		(n = 116)		(n = 49)
Years of age (mean, SD)	47.6	11.7	47.4	11.9	47.3	12.1	47.5	11.4	47.9	12.1
Sex (n, %)
Female	968	45.4%	203	45.4%	125	44.3%	54	46.6%	24	49.0%
Race (n, %)
White	1,570	73.7%	340	76.1%	214	75.9%	90	77.6%	36	73.5%
Other/unknown	560	26.3%	107	23.9%	68	24.1%	26	22.4%	13	26.5%
BMI^b (kg/m^2) (mean, SD)	30.2	6.1	31.1	6.6	30.1	6.3	31.9	5.1	34.8	10.0
BMI group (n, %)
Underweight/normal (≤18.5–24.9)	40	1.9%	14	0.7%	13	4.6%	0	0.0%	1	2.0%
Overweight/obese (>25)	168	7.9%	61	2.9%	33	11.7%	20	17.2%	8	16.3%
Unknown	1,922	90.2%	372	83.2%	236	83.7%	96	82.8%	40	81.6%
CCI^c (mean, SD)	0.3	0.6	0.2	0.6	0.2	0.6	0.2	0.6	0.3	0.6
Top 10 most common comorbidities during the baseline period^d (n, %)
Essential hypertension (ICD9: 401)	389	18.3%	73	16.3%	50	17.7%	14	12.1%	9	18.4%
Disorders of lipid metabolism (ICD9: 272)	348	16.3%	77	17.2%	50	17.7%	16	13.8%	11	22.4%
Other and unspecified joint disorders (ICD9: 719)	255	12.0%	50	11.2%	27	9.6%	12	10.3%	11	22.4%
General symptoms such as fatigue or sleep disturbances (ICD-9 780)	244	11.5%	54	12.1%	38	13.5%	11	9.5%	5	10.2%
Other dematoses (ICD9: 702)	221	10.4%	36	8.1%	26	9.2%	7	6.0%	3	6.1%
Benign neoplasm of the skin (ICD9: 216)	221	10.4%	36	8.1%	26	9.2%	8	6.9%	2	4.1%
Diabetes mellitus (ICD9: 250)	188	8.8%	35	7.8%	24	8.5%	5	4.3%	6	12.2%
Respiratory system symptoms and other chest symptoms (ICD9: 786)	179	8.4%	35	7.8%	22	7.8%	9	7.8%	4	8.2%
Other and unspecified back disorders (ICD9: 724)	178	8.4%	34	7.6%	27	9.6%	3	2.6%	4	8.2%
Other disorders of soft tissues (ICD9: 729)	174	8.2%	35	7.8%	26	9.2%	5	4.3%	4	8.2%
Top 10 most common comorbidities during the follow-up period^d (n, %)
Essential hypertension (ICD9: 401)	767	36.0%	166	37.1%	108	38.3%	40	34.5%	18	36.7%
Disorders of lipid metabolism (ICD9: 272)	734	34.5%	167	37.4%	106	37.6%	41	35.3%	20	40.8%
General symptoms such as fatigue or sleep disturbances (ICD-9 780)	594	27.9%	112	25.1%	69	24.5%	32	27.6%	11	22.4%
Other and unspecified joint disorders (ICD9: 719)	526	24.7%	100	22.4%	60	21.3%	25	21.6%	15	30.6%
Respiratory system symptoms and other chest symptoms (ICD9: 786)	521	24.5%	101	22.6%	62	22.0%	26	22.4%	13	26.5%
Other disorders of soft tissues (ICD9: 729)	410	19.2%	73	16.3%	44	15.6%	23	19.8%	6	12.2%
Other and unspecified back disorders (ICD9: 724)	391	18.4%	76	17.0%	58	20.6%	12	10.3%	6	12.2%
Other dematoses (ICD9: 702)	330	15.5%	71	15.9%	46	16.3%	18	15.5%	7	14.3%
Diabetes mellitus (ICD9: 250)	314	14.7%	62	13.9%	44	15.6%	11	9.5%	7	14.3%
Non-specific findings on examination of blood (ICD9: 790)	313	14.7%	74	16.6%	45	16.0%	20	17.2%	9	18.4%

^aDemographic and clinical characteristics were measured as of the index date, unless otherwise specified.

^bBody mass index (BMI) at index was calculated by taking the height and weight recorded (on the same day) either on or closest to the index date (within a window of ±90 days from the index date).

^cCharlson-Deyo Comorbidity Index (CCI) score²⁹.

^dBased on ≥1 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM, ICD9) diagnosis code at the 3-digit level for the given condition during the respective time period.

Abbreviations. SD, standard deviation; kg, kilogram; m, meter.

Figure 1. Median number of outpatient encounters (all-cause and psoriasis-related) during the follow-up period, stratified by disease severity.

Figure 2. Proportion of prescription medication claims that were psoriasis-related during the follow-up period, stratified by disease severity.

Table 2. Healthcare resource utilization during the follow-up period, overall and stratified by disease severity.

Healthcare resource utilization^a	Biologic cohort, All		Biologic cohort, with recorded disease severity		Biologic cohort, Mild disease severity		Biologic cohort, Moderate disease severity		Biologic cohort, Severe disease severity
	(n = 2,130)		(n = 447)		(n = 282)		(n = 116)		(n = 49)
All-cause (mean, median)
Total number of outpatient encounters^b	43.9	32	40.2	31	40.1	28	39.2	32	43.8	36
Physician office visits	12.1	8	11.8	8	11.4	8	12.0	9	13.9	9
Total number of emergency department (ED) visits^c	0.3	0	0.2	0	0.2	0	0.3	0	0.3	0
Total number of inpatient visits	0.1	0	0.1	0	0.1	0	0.1	0	0.2	0
Cumulative number of inpatient days^d	6.3	4	10.2	5	7.6	5	4.5	4	26.8	7
Total number of all prescription medication claims^e	36.3	28	34.8	26	35.4	26.5	33.2	26	35.5	24
Psoriasis-related^f (mean, median)
Total number of outpatient encounters^b	7.0	5	8.7	7	8.2	6	9.6	7.5	9.8	8
Physician office visits	2.5	2	3.1	3	2.8	2.5	3.7	3	3.7	3
Total number of emergency department (ED) visits^c	0.0	0	0.0	0	0.0	0	0.0	0	0.0	0
Total number of inpatient visits	0.0	0	0.0	0	0.0	0	0.0	0	0.1	0
Cumulative number of inpatient days^d	4.8	4	5.4	5	5.0	5	3.3	2.5	11.0	11
Total number of all psoriasis prescription medication claims^e	10.7	10	10.8	10	10.0	9	12.3	11	12.2	11
Total number of all biologic psoriasis prescription medication claims^e	7.5	8	7.4	7	7.6	8	7.4	8	6.0	5

^aAs assessed during the follow-up period, excluding the index date.

^bOffice visits were summarized by patient, provider, and date. Therefore, if a patient saw the same provider three times on the same day then that was recorded as one office visit. However, if a patient saw three different providers on the same day then that was recorded as three office visits. All other outpatient categories (i.e. “Lab”, “Pathology”, “Radiology”, “Surgical Services”, and “Ancillary/Other Outpatient Services”) are summarized only by patient and procedure. Therefore, if a patient had three different lab tests drawn on the same day then those three lab tests were counted as three separate events.

^cEmergency department (ED) visits that transitioned to inpatient visits were counted as both ED visits and inpatient visits.

^dAmong the n = 154 patients with ≥1 all-cause inpatient stay and n = 34 patients with ≥1 PsO-related inpatient stay.

^eIncluding medications recorded using J-codes.

^fPsoriasis-related was defined as any claim associated with a diagnosis for psoriasis and/or psoriatic arthritis and/or any NDC/HCPCS/CPT for medications indicated for psoriasis.

Figure 3. Median total and pharmacy costs (all-cause and psoriasis-related) during the follow-up period, stratified by disease severity.

Table 3. Healthcare resource costs during the follow-up period, overall and stratified by disease severity (payer and patient combined).

	Biologic cohort, All		Biologic cohort, with recorded disease severity		Biologic cohort, Mild disease severity		Biologic cohort, Moderate disease severity		Biologic cohort, Severe disease severity
Healthcare costs^a	(n = 2,130)		(n = 447)		(n = 282)		(n = 116)		(n = 49)
All-cause (mean, median)
Total healthcare costs (overall)	$42,051	$36,293	$46,323	$39,583	$44,830	$37,743	$43,970	$42,270	$60,485	$49,318
Total outpatient costs	$5,070	$2,179	$4,456	$2,134	$4,272	$1,972	$4,060	$2,555	$6,448	$2,568
Physician office visits	$1,423	$850	$1,270	$888	$1,214	$840	$1,247	$989	$1,646	$889
Total emergency department (ED) costs	$288	—	$285	—	$164	—	$513	—	$441	—
Total inpatient costs	$1,998	—	$2,979	—	$2,523	—	$1,580	—	$8,913	—
Total pharmacy costs^b	$34,696	$31,830	$38,604	$34,362	$37,870	$33,912	$37,818	$36,485	$44,682	$36,386
Psoriasis-related^c (mean, median)
Total healthcare costs (overall)	$32,549	$30,446	$37,440	$33,429	$36,394	$32,661	$37,418	$34,867	$43,509	$40,462
Total outpatient costs	$470	$257	$632	$343	$489	$321	$535	$366	$1,684	$371
Physician office visits	$246	$177	$308	$241	$273	$237	$337	$268	$441	$271
Total emergency department (ED) costs	$23	—	$41	—	$10	—	$134	—	$5	—
Total inpatient costs	$411	—	$891	—	$873	—	$712	—	$1,413	—
Total pharmacy costs^b	$31,646	$29,898	$35,876	$32,778	$35,022	$32,161	$36,037	$33,935	$40,406	$35,595

^aAs assessed during the follow-up period, excluding the index date.

^bIncluding medications recorded using J-codes.

^cPsoriasis-related was defined as any claim associated with a diagnosis for psoriasis and/or psoriatic arthritis and/or any National Drug Codes (NDC)/Healthcare Common Procedure Coding System (HCPCS)/American Medical Association's Current Procedural Terminology (CPT) codes for medications indicated for psoriasis.

Outliers have not been removed from the analyses.

Table 4. Healthcare resource costs during the follow-up period, overall and stratified by disease severity (payer only).

	Biologic cohort, All		Biologic cohort, with recorded disease severity		Biologic cohort, Mild disease severity		Biologic cohort, Moderate disease severity		Biologic cohort, Severe disease severity
Healthcare costs^a	(n = 2,130)		(n = 447)		(n = 282)		(n = 116)		(n = 49)
All-cause (mean, median)
Total healthcare costs (overall)	$38,964	$33,435	$43,216	$36,877	$41,779	$34,121	$40,870	$39,214	$57,037	$44,982
Total outpatient costs	$4,085	$1,569	$3,693	$1,565	$3,512	$1,435	$3,282	$1,886	$5,700	$1,915
Physician office visits	$1,000	$594	$963	$645	$915	$597	$942	$710	$1,291	$632
Total emergency department (ED) costs	$234	—	$247	—	$138	—	$451	—	$394	—
Total inpatient costs	$1,883	—	$2,832	—	$2,419	—	$1,348	—	$8,724	—
Total pharmacy costs^b	$32,762	$29,987	$36,444	$32,657	$35,709	$32,093	$35,789	$33,452	$42,219	$33,724
Psoriasis-related^c (mean, median)
Total healthcare costs (overall)	$30,858	$28,538	$35,446	$31,594	$34,441	$30,821	$35,455	$32,264	$41,208	$35,361
Total outpatient costs	$355	$158	$491	$214	$359	$202	$367	$248	$1,544	$285
Physician office visits	$171	$104	$214	$150	$186	$138	$227	$173	$340	$183
Total emergency department (ED) costs	$20	—	$36	—	$8	—	$117	—	$5	—
Total inpatient costs	$385	—	$835	—	$821	—	$649	—	$1,356	—
Total pharmacy costs^b	$30,098	$28,076	$34,084	$31,004	$33,253	$30,409	$34,321	$32,041	$38,303	$33,138

^aAs assessed during the follow-up period, excluding the index date.

^bIncluding medications recorded using J-codes.

^cPsoriasis-related was defined as any claim psoriasis with a diagnosis for psoriasis and/or psoriatic arthritis and/or any National Drug Codes (NDC)/Healthcare Common Procedure Coding System (HCPCS)/American Medical Association’s Current Procedural Terminology (CPT) codes for medications indicated for psoriasis.

Outliers have not been removed from the analyses.

Table 5. Healthcare resource costs during the follow-up period, overall and stratified by disease severity (patient only).

	Biologic cohort, All		Biologic cohort, with recorded disease severity		Biologic cohort, Mild disease severity		Biologic cohort, Moderate disease severity		Biologic cohort, Severe disease severity
Healthcare costs^a	(n = 2,130)		(n = 447)		(n = 282)		(n = 116)		(n = 49)
All-cause (mean, median)
Total healthcare costs (overall)	$3,087	$1,948	$3,107	$2,159	$3,051	$2,144	$3,100	$2,140	$3,448	$2,704
Total outpatient costs	$985	$412	$763	$434	$760	$392	$778	$472	$748	$359
Physician office visits	$423	$208	$306	$209	$299	$197	$305	$245	$355	$221
Total emergency department (ED) costs	$53	—	$38	—	$26	—	$61	—	$48	—
Total inpatient costs	$115	—	$147	—	$104	—	$232	—	$189	—
Total pharmacy costs^b	$1,934	$932	$2,160	$1,067	$2,161	$1,104	$2,030	$884	$2,463	$1,258
Psoriasis-related^c (mean, median)
Total healthcare costs (overall)	$1,691	$645	$1,993	$881	$1,952	$842	$1,963	$863	$2,301	$1,186
Total outpatient costs	$116	$63	$140	$95	$129	$88	$168	$117	$140	$93
Physician office visits	$75	$52	$94	$74	$87	$64	$110	$84	$101	$82
Total emergency department (ED) costs	$2	—	$6	—	$2	—	$17	—	—	—
Total inpatient costs	$25	—	$55	—	$52	—	$63	—	$58	—
Total pharmacy costs^b	$1,548	$484	$1,792	$623	$1,769	$614	$1,716	$596	$2,104	$681

^aAs assessed during the follow-up period, excluding the index date.

^bIncluding medications recorded using J-codes.

^cPsoriasis-related was defined as any claim psoriasis with a diagnosis for psoriasis and/or psoriatic arthritis and/or any National Drug Codes (NDC)/Healthcare Common Procedure Coding System (HCPCS)/American Medical Association’s Current Procedural Terminology (CPT) codes for medications indicated for psoriasis.

Note: Outliers have not been removed from the analyses.

Figure 4. Average total healthcare and pharmacy costs (all-cause and psoriasis-related) during the follow-up period (n = 2,130).

Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43:1130–9

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