Treatment patterns and healthcare costs among biologic-naive patients initiating apremilast or biologics for the treatment of psoriatic arthritis: results from a US claims analysis

Abstract

Objective: Information on treatment costs for psoriatic arthritis (PsA) can be valuable for payers and providers who make treatment and formulary decisions. This study compared real-world treatment patterns and healthcare costs among biologic-naive patients with PsA initiating apremilast or biologics.

Methods: A retrospective cohort study was conducted using the Optum Clinformatics™ claims database. The study included biologic-naive patients with PsA who initiated treatment with apremilast or a biologic between 1 January 2014, and 31 December 2015. Propensity score matching was used to adjust for selection bias. Treatment persistence/adherence and all-cause healthcare costs were evaluated. Cost differences were determined using Wilcoxon rank-sum tests.

Results: In all, 125 biologic-naive patients initiating treatment with apremilast were matched to 245 biologic-naive patients initiating treatment with a biologic. Twelve-month treatment persistence was similar for apremilast vs. biologic users (43.2 vs. 36.7%; p = .2277). While persistent on treatment for up to 12 months, total healthcare costs (from all utilizations) were significantly lower among apremilast vs. biologic users ($28,130 vs. $37,093; p < .0001). Likewise, per-patient per-month costs while persistent on treatment were significantly lower among apremilast vs. biologic users whether they switched treatments ($2,455 vs. $3,497; p = .0103), remained persistent on treatment ($2,434 vs. $3,521; p < .0001), or discontinued but did not switch treatments ($2,178 vs. $2,696; p = .0082).

Conclusions: Apremilast patients had significantly lower healthcare costs than biologic patients, even when they switched to a biologic, during the 12-month post-index period. These results may be useful to payers and providers seeking to optimize PsA care while reducing healthcare costs.

Keywords:

• Apremilast
• biologics
• healthcare cost
• psoriatic arthritis
• treatment pattern

Transparency

Declaration of funding

This study was funded by Celgene Corporation. The authors currently employed by Celgene Corporation were involved in the preparation of the manuscript.

Declaration of financial/other relationships

J.J.W. has disclosed that he has served as an investigator for AbbVie, Amgen, Eli Lilly, Janssen, and Novartis; a consultant for AbbVie, Almirall, Amgen, BMS, Celgene Corporation, Dermira, Dr. Reddy's Laboratories, Eli Lilly, Janssen, LEO Pharma, Novartis, Ortho Dermatologics, Promius Pharma, Regeneron, Sun Pharmaceutical, and UCB; and a speaker for Celgene Corporation, Novartis, Sun Pharmaceutical, UCB, and Valeant. C.P., B.U., and M.T. have disclosed that they are employees of Celgene Corporation.

A peer reviewer on this manuscript has disclosed that they work full time for Novartis. Another peer reviewer has disclosed that they have received research, speaking, and/or consulting support from a variety of companies, including Galderma, GSK/Stiefel, Almirall, Alvotech, LEO Pharma, BMS, Boehringer Ingelheim, Mylan, Celgene Corporation, Pfizer, Ortho Dermatology, Abbvie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate, and National Psoriasis Foundation. They also consult for others through Guidepoint Global, Gerson Lehrman, and other consulting organizations. They are the founder and majority owner of www.DrScore.com. They are a founder and part-owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

All authors participated in the study design, data interpretation, and manuscript review and revisions and granted approval for the submission of the manuscript. All authors had full access to all of the data and agree to be accountable for all aspects of the work.

Acknowledgements

Editorial support was provided by Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, USA, sponsored by Celgene Corporation, Summit, NJ, USA. The authors, however, directed and are fully responsible for all content and editorial decisions for this report.

Data availability

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