Healthcare Resource Utilization and Costs in Patients with Psoriasis Who Switched to Biologic or Phosphodiesterase 4 Inhibitor Therapies Due to Inadequate Response


Curtis JR1, Grabner M2, Burge R3, Teng CC2, Shan M4, Garrelts A4, Ridenour T4, Isenberg K5
1University of Alabama at Birmingham, Birmingham, AL, USA, 2HealthCore, Inc., Wilmington, DE, USA, 3Eli Lilly and Company, Indianapolis, USA; Division of Pharmaceutical Sciences, University of Cincinnati, Indianapolis, IN, USA, 4Eli Lilly and Company, Indianapolis, IN, USA, 5Anthem Inc., Indianapolis, IN, USA

OBJECTIVES: To assess healthcare resource utilization (HCRU)/costs for therapy switchers and non-switchers who previously had inadequate response (IR) to biologic/phosphodiesterase 4 inhibitor (PDE4i) treatment for psoriasis.

METHODS: A retrospective, observational, claims-based cohort study was conducted using the HealthCore Integrated Research Database®. Index date was start date of biologic/PDE4i, ascertained 01-Jul-2016 to 31-Aug-2018. Adult patients (≥18 years) with psoriasis having IR to initial biologic/PDE4i 12 months after starting therapy and ≥6-months pre-index and ≥12-months post-switch continuous health plan enrollment were included. Non-switchers were assigned an imputed switch date according to switch date distribution (by month) for switchers. IR was defined as <80% biologic/PDE4i adherence; switching to non-index biologic/PDE4i; increasing index therapy dose/frequency; adding/increasing oral glucocorticoid dose/frequency; adding new conventional therapy/topical treatment/actinotherapy/retinoids/pain medication class. HCRU frequency and costs were compared during 6 months pre-index, 12 months pre-switch, and 12 months post-switch between switchers and non-switchers, without further adjustments.

RESULTS: The study included 1,122 patients with psoriasis (202 switchers and 920 non-switchers) having IR to biologic/PDE4i. Pre-index, mean systemic therapies pharmacy fill frequency was higher among switchers than non-switchers (0.7 vs. 0.3, p<0.01). Pre-switch, switchers compared with non-switchers had significantly (p<0.01) higher mean all-cause per-patient per-month outpatient visits (2.0 vs. 1.5), outpatient specialist visits (0.6 vs. 0.3), and all-cause prescription drug fills (2.1 vs. 1.9). Post-switch mean systemic therapies pharmacy fill frequency was also higher among switchers than non-switchers (7.8 vs. 4.0, p<0.01). Pre-index mean all-cause total costs were higher in switchers than non-switchers ($5840 vs. $4382, p<0.01). After switching, mean pharmacy and all-cause total costs were higher in switchers than non-switchers ($61,574 vs. $25,629 and $69,133 vs. $32,230; both p<0.01).

CONCLUSIONS: Among patients with psoriasis having IR to biologic/PDE4i, switching was associated with higher HCRU and all-cause total costs, which emphasizes importance of selecting an appropriate index therapy to maximize potential for adequate response.

Conference/Value in Health Info

2021-05, ISPOR 2021, Montreal, Canada

Value in Health, Volume 24, Issue 5, S1 (May 2021)




Economic Evaluation, Organizational Practices, Real World Data & Information Systems

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis, Health & Insurance Records Systems, Industry


Biologics and Biosimilars

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