Healthcare resource utilization, healthcare costs and dose escalation in psoriasis patients initiated on ustekinumab versus adalimumab: a retrospective claim study

Abstract

Background: Adalimumab and ustekinumab are effective psoriasis treatments. This study compares healthcare resource utilization (HRU), costs and dose escalation and describes starting dose trends in ustekinumab versus adalimumab psoriasis patients.Methods: Adult psoriasis patients initiating adalimumab/ustekinumab on/after 25 September 2009 were selected from a US claims database and classified into biologic-naïve and biologic-experienced samples.Results: A total of 602 ustekinumab and 3470 adalimumab biologic-naïve and 1193 ustekinumab and 1467 adalimumab biologic-experienced patients were included. In both samples, ustekinumab patients had significantly more days with medical services (biologic naïve: IRR =1.14; biologic experienced: IRR =1.08) and higher average total costs by more than $14,000 annually. Ustekinumab users were 2.6 and 1.9 times more likely to have a dose escalation (increase ≥45 mg in ustekinumab; ≥40 mg in adalimumab) in biologic-naive and biologic-experienced patients, respectively. Between S2/2009 and S1/2012, the proportion of patient initiating on high dose (ustekinumab: >45 mg/28 days; adalimumab: >160 mg/28 days) increased substantially for ustekinumab patients (biologic naïve: +18.6 percentage points [PP]; biologic experienced: +29.9 PP) but remain stable for adalimumab patients (biologic naïve: −0.3 PP; biologic experienced: +2.3 PP).Conclusion: Ustekinumab patients had more HRU, higher total costs and were more likely to have a dose escalation. The proportion of patients initiating ustekinumab high dose increased substantially between 2009 and 2012.