OBJECTIVES: Biologics offer major advances in psoriasis treatment, but many patients discontinue and/or switch biologics. No study to date has compared the healthcare costs associated with these varying treatment utilization patterns in the U.S. Medicare population.

METHODS: Utilizing 2009-2014 100% Medicare claims, we examined costs by treatment pattern for 12-months after fee-for-service Medicare Part D patients with psoriasis initiated biologics (index biologic). Patients could (1) switch to a new biologic within 90-days of a previous biologic prescription, or after a > RESULTS: Mean all-cause costs and non-biologic costs were $49,839 (SD=$33,548) and $21,873 (SD=$30,630), respectively, in the overall sample of 4949 patients (55% non-discontinuers, 7.5% switchers, 7.1% reinitiators-same biologic, 1.5% reinitiators-new biologic, 28.9% discontinuers). Compared to non-discontinuers, risk-adjusted all-cause costs were higher for switchers (+$2,743) and lower for reinitiators-same biologic (-$9,610), reinitiators-new biologic (-$6,714), and discontinuers (-$14,329) (p<0.01 for all). However, examination of the non-biologic all-cause costs revealed that all four groups had higher costs than non-discontinuers with statistically significant findings for reinitiators-same biologic (+$4,931, p<0.01) and discontinuers (+$7,587, p<0.01).

CONCLUSIONS: Switching of biologics for psoriasis was associated with higher all-cause costs. As expected, a >