Drug Utilisation And Healthcare Resources Use In Patients With Psoriatic Arthritis And Psoriasis

Abstract

This study aimed to assess therapeutic strategies in clinical practice for patients with psoriatic arthritis (PsA) or psoriasis and calculate related healthcare resources consumption. An observational retrospective cohort analysis was conducted based on administrative databases from 2 Italian local health units (LHUs), ≈1.6 million beneficiaries. Citizens who were diagnosed with PsA or psoriasis and had a biologic prescription from January 1, 2010, to December 31, 2013 (index date) were included. Patients were classified as biologic-naïve or biologic-established according to previous biologic treatment, and analysed 1 year back to assess resource consumption in the 2 groups. According to findings from the 2 LHUs, 86% of biologic-naive patients had previous disease-modifying anti-rheumatic drug (DMARD) prescriptions and 47% had previous topical anti-psoriatic prescriptions. Exposure to DMARDs and anti-psoriatic drugs was lower in biologic-established patients (43% and 33%, respectively). Yearly incidence of disease-related hospitalisations before the index date was 7% in biologic-naive and 13% in biologic-established patients. Biologic-naïve patients had longer average hospital lengths of stay. The average cost of illness in the 12 months before the first biologic prescription (biologic-naïve) was ≈760€, with 530€ for DMARDs, 130€ for anti-psoriatics, and 101€ for inpatient stays. Non-PsA/psoriasis-related costs were 790€, of which 57% were due to hospitalisations. Biologic-established patients’ yearly expenditure accounted for 10,410€ for biologic treatment, 265€ for other PsA/psoriasis drugs (168€ DMARDs, 70€ anti-psoriatics, 26€ corticosteroids), and 410€ for hospitalisations. Non-disease-related expenditure was 630€, with >80% due to drug consumption. At the index date, consumption of DMARDs and other anti-psoriatics was lower in biologic-established than biologic-naïve patients (43% vs 86% and 33% vs 47%, respectively), but overall drug expenditure was higher due to biologic acquisition cost (10,410€ vs 760€). Disease-related hospitalisations were higher in biologic-established patients treated the year before the index date (13% vs 7% of biologic-naïve patients).