Background Despite advances in psoriatic arthritis (PsA) and psoriasis (PsO) therapies, and EULAR and ACR treatment guidelines, many patients remain untreated or under-treated.
Objectives To provide recent information on treatment patterns, healthcare resource utilization (HCRU) and costs in patients with a diagnosis of PsA only or both PsA and PsO (PsA/PsO) within the same period, using a large, United States national healthcare-claims database. HCRU and costs were examined between those receiving initial treatment vs those initially untreated.
Methods Patients aged ≥18 years with ≥2 outpatient or 1 inpatient visit for psoriatic disease (ICD-9: 696.1 or 696.0) were identified in the Truven Marketscan® Claims Database (Q2 2009 - Q1 2014) who were continuously enrolled ≥6 months before and ≥12 months after first PsA or PsO diagnosis (index; Day 0). This study focused on patients with PsA with or without PsO. Initial (≤30 days of index date) treatment patterns were classified as monotherapy (1 class) and combination regimen. Combination regimens were defined hierarchically as biologics plus other, conventional systemic (CS) plus other non-biologic, phototherapy and topical plus other non-biologic or non-CS. Unadjusted PsA/PsO- and PsA-related HCRU and costs were calculated 1 year post-index. Only those patients that had HCRU data were analyzed.
Results 7512 patients with PsA and 10226 with PsA/PsO were included; 46.7% (PsA), and 46.0% (PsA/PsO) received initial treatment; the table summarises patients, treatments and HCRU at 1 year post-index date; 76% (PsA) and 75% (PsA/PsO) of patients who did not receive initial treatment were not treated 31-90 days post-index. Also, 63% (PsA) and 59% (PsA/PsO) of patients not initially treated received no treatment 181-365 days post-index.
In PsA patients, mean [standard deviation; SD] PsA-related pharmacy costs were $8395  with initial treatment, vs $5103  with no initial treatment (p<0.0001). Mean [SD] related outpatient office costs were $1205  with initial treatment, vs $667  with no initial treatment (p<0.0001). Mean [SD] related inpatient and emergency room (ER) costs were not significantly different in patients initially treated vs not initially treated (p=0.7 for both).
In PsA/PsO patients, mean [SD] PsA/PsO-related pharmacy costs were $7981  with initial treatment, vs $5128  with no initial treatment (p<0.0001). Mean [SD] related outpatient office costs were $1127  with initial treatment, vs $846  with no initial treatment (p<0.0001). Mean [SD] related inpatient and ER costs were not significantly different in patients initially treated vs not initially treated (p=1.0 for inpatient, p=0.5 for ER).
Conclusions This recent study revealed a continued substantial burden of illness and HCRU with PsA only and PsA/PsO. Most patients did not receive initial treatment (within 30 days of diagnosis); in this unadjusted analysis initial treatment was associated with increased drug and outpatient costs and HCRU vs no initial treatment. Total costs were generally similar for PsA cohorts with and without PsO. To our knowledge, this study is the first to examine HCRU in patients with PsA only and PsA/PsO.
Acknowledgements Medical writing support by Kate Silverthorne, PhD, Complete Medical Communications, funded by Pfizer Inc.
Disclosure of Interest M.-A. Hsu Shareholder of: Pfizer, Employee of: Pfizer, J. Harnett Shareholder of: Pfizer, Employee of: Pfizer, B. Emir Shareholder of: Pfizer, Employee of: Pfizer, L. Mallbris Shareholder of: Pfizer, Employee of: Pfizer, W. Ports Shareholder of: Pfizer, Employee of: Pfizer, C. Mamolo Shareholder of: Pfizer, Employee of: Pfizer