OBJECTIVES

Psoriasis is a chronic inflammatory disorder. Information on real-world healthcare costs associated with apremilast and biologic therapy is limited. This study examined healthcare costs among biologic-naive psoriasis patients who initiated treatment with apremilast or a biologic.

METHODS

Adult patients with psoriasis were identified if they initiated treatment with either apremilast, a tumor necrosis factor (TNF) inhibitor (adalimumab, certolizumab, etanercept, golimumab or infliximab) or an interleukin (IL) inhibitor (ixekizumab, secukinumab or ustekinumab) between January 1, 2015, and December 31, 2016, and had a minimum of 12 months pre-index and post-index continuous enrollment in the Truven Health (now IBM Watson Health) MarketScan^® Commercial and Medicare Supplemental Database. The study used 1:1 propensity score matching between apremilast and biologic patients based on available demographics and clinical characteristics. Total healthcare costs were measured by type of service (inpatient, outpatient and outpatient pharmacy) and were based on paid amounts of adjudicated claims. Costs were reported at 6, 12 and 18 months. T-test, Wilcoxon rank-sum test and chi-squared test were used to evaluate differences between the cohorts for continuous and categorical variables, as appropriate.

RESULTS

In all, 1,645 biologic-naive psoriasis patients initiating apremilast were matched to 1,645 biologic-naive psoriasis patients initiating biologics (TNF: n=1,207; IL: n=438). Patient characteristics were similar between the 3 cohorts (mean age: 47.5 [apremilast], 48.1 [TNF], 46.4 [IL] years; Charlson Comorbidity Index: 0.45 [apremilast], 0.47 [TNF], 0.39 [IL]). Twelve-month total costs were significantly lower among apremilast initiators vs TNF and IL initiators ($34,028 vs $55,973 and $64,430; both P<0.0001). Outpatient pharmacy costs were significantly lower for apremilast patients vs TNF and IL patients ($27,818 vs $50,070 and $58,871; both P<0.0001). Similar results were seen at 6 and 18 months post-index.

CONCLUSIONS

Biologic-naive psoriasis patients initiating apremilast had significantly lower healthcare costs than patients initiating TNF and IL inhibitors.