Economic impact of biologic utilization patterns in patients with psoriatic arthritis

Abstract

The aim of the study is to examine the frequency and costs associated with above-label dosing of biologics in patients with psoriatic arthritis (PsA). MarketScan identified adults with ≥1 International Classification of Diseases, Clinical Modification diagnosis for PsA and ≥1 pharmacy claim for biologics of interest between January 1, 2011 and December 31, 2013. The first biologic claim was the index date with a 1-year follow-up period and three additional months to confirm continuous biologic use. Exclusion criteria included switching to a different biologic or diagnosis with another autoimmune disease. During the follow-up period, duration was stratified into three groups: <30, 30–179, and ≥180 days of above-label dosing (>10% of the labeled dose). One-tailed t test was conducted to examine the impact of above-label duration on healthcare costs. We identified 4245 PsA patients receiving etanercept (n = 2342), adalimumab (n = 1788), and golimumab (n = 115). Above-label dosing of <30 days (85% adalimumab, 90.4% etanercept, and 95.7% golimumab) and ≥180 days (9.6% adalimumab, 4.1% etanercept, and 2.6% golimumab) was observed. All-cause total healthcare costs for <30 days of above-label use (etanercept $30,625, adalimumab $31,620, and golimumab $37,224), 30–179 days (etanercept $35,602, adalimumab $38,915, and golimumab $64,349), and ≥180 days (etanercept $55,349, adalimumab $54,176, and golimumab $47,993) were reported. Longer above-label duration (30–179 versus <30 days, ≥180 versus 30–179 and ≥180 days) with etanercept or adalimumab was significantly associated with higher mean increased total all-cause healthcare, PsA-specific healthcare, and biologic costs (p < 0.05). Above-label use of anti-TNF biologics does occur and is associated with significantly increased healthcare costs.

Treatment patterns and costs among biologic-naive patients initiating apremilast or biologics for psoriatic arthritis

“…Patients treated with apremilast have lower pharmacy costs in addition to lower outpatient medical costs and lower total healthcare costs, suggesting that savings may be related to reductions in expenditures for outpatient care or laboratory fees to monitor or treat adverse events that have been associated with biologics. Comparison to previous administrative-based claims analyses of patients with PsA is challenging due to differences in study methodology; however, our 1-year total direct cost results for PsA patients treated with biologics were consistent with previous publications that evaluated the total costs and total pharmacy costs for PsA patients treated with biologics [23,24]. Our 1-year total pharmacy cost estimates were slightly lower than one previous study that included apremilast and estimated the 1-year pharmacy costs per responding patient to be $53,704 for apremilast, $56,273 for adalimumab and $65,750 for etanercept (2014 US dollars) [25].…”

Persistence and adherence of biologics in US patients with psoriatic arthritis: analyses from a claims database

“…Unlike previous real-world studies that have shown shorter persistence with subsequent lines of biologic therapy in patients with PsA, in our study discontinuation rates and time to discontinuation were similar between biologic-naive and -experienced patients (43.4 and 44.3%, respectively), but additional adjusted analyses are needed to better understand factors associated with persistence [33,40]. The mean PDC with adalimumab (0.65), certolizumab pegol (0.49), etanercept (0.60) and golimumab (0.59) in our study was slightly lower than those previously reported among patients with PsA from the same database at 12-months of follow-up (mean PDC = 0.8 for adalimumab, etanercept and golimumab) [41], and comparable to analysis of another administrative claims database (adalimumab [0.56], certolizumab pegol [0.51], etanercept [0.57] and golimumab [0.61]) [34]. The overall proportion of patients adherent (PDC ≥0.8) to their index therapy is also similar to what was previously observed during the first year of therapy in patients with PsA, ankylosing spondylitis or rheumatoid arthritis who initiated an sc.…”

Switch rates and total cost associated with apremilast and biologics in biologic-naive patients with psoriatic arthritis

“…Our findings are also consistent with a study of real-world costs among biologic-naive PsA patients conducted by Feldman et al, which showed that apremilast initiators had lower healthcare costs compared with patients treated with biologics, primarily due to lower outpatient pharmacy costs [15]. The higher pharmacy costs observed with biologics in our study may also be due to off-label dosing; in a study of anti-TNF therapy for PsA by Schwartzman et al, off-label dosing was associated with significantly higher healthcare costs [22].…”