Background Psoriatic arthritis (PsA) is a disease with clinical components of psoriasis and arthritis. The annual direct (inpatient, outpatient, and pharmacy) mean per patient healthcare cost of PsA has been estimated to be $3,638 in the United States (U.S.). This estimate, however, is a decade old and does not account for new treatments, changes in diagnostic procedures, or updated reimbursement policies. PsA biologic treatments, which have emerged over the last decade, have demonstrated superior efficacy in PsA compared to older therapies such as methotrexate. Golimumab (GLM) is a biologic agent, U.S. Food and Drug Administration-approved in 2009, for the treatment of PsA. Limited recent data exist describing the current economic burden of PsA in the U.S.
Objectives To describe the 2-year disease-related U.S. direct healthcare costs of PsA patients prior to initiating GLM (baseline).
Methods The IMS LifeLink™ Health Plan Claims database was utilized to identify patients who had/were: index golimumab pharmacy claim started 4/24/2009-06/30/2010; aged ≥18 years at index; ≥1 PsA ICD-9 diagnosis code (696.0); and 24 months pre- and ≥6 months post-index continuous enrollment. Total disease-related direct healthcare costs included medical (inpatient, outpatient) and pharmacy (biologic and non-biologic treatment) costs. Disease-related allowable healthcare costs were calculated from outpatient and inpatient claims with an ICD-9 diagnosis code for PsA (696.0) or rheumatoid arthritis (RA-714.xx). Pharmacy costs were calculated from allowed costs for biologic and non-biologic treatments used in PsA, RA, or psoriasis (PsO).
Results A total of 211 GLM patients with PsA (n=180 with pre-index biologic experience) were analyzed; mean±SD age was 50±10; 61.1% female. Concomitant diagnosis codes for RA or PsO were found in 39.8% and 51.2% of all PsA patients, respectively. Total mean±SD pre-index PsA-related costs were $3,569±$9,231. Mean PsA-related outpatient medical costs represented 92.0% of total PsA-related costs. Among the 114 patients with a comorbid RA diagnosis code, overall mean pre-index total RA-related costs were $2,186. Mean disease-related pharmacy costs for the 2-year period prior to GLM totaled $28,041. Based on the disease-related outpatient, inpatient, and pharmacy costs, the 2-year direct mean per patient disease-related healthcare costs in PsA was $32,791.
Conclusions In this study, annual per patient direct PsA U.S. healthcare costs were $16,369. This new economic burden of illness estimate may further aid decision-makers in assessing the cost-effectiveness and budgetary impact of PsA therapies, including biologics. This estimate, however, should be considered in the context of incremental improvements in clinical outcomes associated with biologic treatments compared with older PsA therapies.
Disclosure of Interest C. Carter Employee of: Janssen Scientific Affairs, LLC, D. Smith Consultant for: Janssen Scientific Affairs, LLC, N. Tandon Employee of: Janssen Scientific Affairs, LLC
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