OBJECTIVES : Apremilast and biologics are commonly used as second-line treatments in Europe for moderate to severe plaque psoriasis, following conventional systemic disease-modifying antirheumatic drugs (i.e., csDMARDs). Previously, trial-based economic models demonstrated the cost-effectiveness of using apremilast earlier in treatment. Real-world costs associated with use of therapy also warrant exploration. Cost differences between csDMARD-experienced psoriasis patients newly initiating apremilast vs. a biologic were evaluated here.

METHODS : A retrospective analysis was conducted using WIG2 database, comprising ~4 million German healthcare claims. Adults were selected if they: (1) newly initiated apremilast or a biologic during Feb2015-Jun2017 (assigned treatment group and index date), (2) were continuously enrolled for 12 months pre- and post-index, (3) had ≥1 csDMARD, ≥1 psoriasis diagnosis, and no cancer diagnosis pre-index, and (4) had no other psoriasis treatments within 30 days post-index. A 12-month intention-to-treat analysis was utilized to account for between-group treatment changes and to assess the overall impact of treatment on cost. Descriptive statistics and a linear regression model adjusting for demographics and Charlson Comorbidity Index (CCI) were used. Sensitivity analyses of anti-TNFs and secukinumab (IL-17A) subgroups were conducted. Costs were standardized to 2017€. Statistical significance was considered P≤0.05.

RESULTS : A total of 420 patients were identified (i.e., n_apremilast=124, n_biologics=296, n_anti-TNFs=142, n_secukinumab=97). Users of apremilast were significantly older (mean: 50 vs. 45 years) with higher CCI (mean: 2.81 vs. 1.96) vs. biologics. The unadjusted mean total cost per patient was significantly lower among users of apremilast (17,417€) vs. biologics (29,959€), anti-TNFs (30,372€), and secukinumab (29,486€). Differences were primarily driven by pharmacy costs (e.g., apremilast=14,118€; biologics=26,934€). The adjusted difference in mean total cost per patient was also significantly lower with apremilast vs. biologics (12,934€), anti-TNFs (13,015€), and secukinumab (12,608€).

CONCLUSIONS : Real-world data confirm significant cost-savings with apremilast vs. biologics (average~12,000€/patient), when used after csDMARDs. Limitations of claims data apply.