OBJECTIVES: Psoriatic arthritis (PsA) is a chronic inflammatory disorder. Information on real-world healthcare costs associated with apremilast and biologic therapy in PsA is limited. This study examined healthcare costs among biologic-naive PsA patients who initiated treatment with apremilast or a biologic.

METHODS: Adult patients with PsA were identified if they initiated treatment with either apremilast, a tumor necrosis factor (TNF) inhibitor (adalimumab, certolizumab, etanercept, golimumab, infliximab) or an interleukin (IL) inhibitor (ixekizumab, secukinumab, 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 1:2 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 post-index. T-test, Wilcoxon rank-sum test and chi-squared test were used to evaluate differences between the apremilast and biologic cohorts for continuous and categorical variables, as appropriate.

RESULTS: In all, 1,471 biologic-naive PsA patients initiating apremilast were matched to 890 biologic-naive PsA patients initiating biologics (TNF: n=804; IL: n=86). Patient characteristics were similar between the 3 cohorts (mean age: 50 years; Charlson Comorbidity Index score: 0.58 [apremilast], 0.55 [TNF], 0.56 [IL]). Twelve-month total costs were significantly lower among apremilast initiators vs TNF and IL initiators ($39,854 vs $57,243 and $65,867; both P<0.0001). Outpatient pharmacy costs were significantly lower for apremilast patients vs TNF and IL patients ($29,130 vs $48,540 and $57,038; P<0.0001). Similar results were seen at 6 and 18 months post-index.

CONCLUSIONS: Biologic-naive PsA patients initiating apremilast had significantly lower healthcare costs than patients initiating biologics in a US claims database.