PSY118 - Health Care Costs Associated with Different Biologic Treatment Patterns Among U.S. Medicare Patients with Psoriasis

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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. 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 >90-day gap (2) reinitiate with the same biologic, (3) reinitiate with a new biologic, or (4) discontinue (i.e. no biologic after 90-day gap). The remaining patients were classified as non-discontinuers. Generalized linear models were used to estimate adjusted all-cause and non-biologic costs. Model covariates included sociodemographic, clinical, area-level, plan, and formulary characteristics. 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). Switching of biologics for psoriasis was associated with higher all-cause costs. As expected, a >90-day gap in biologics with or without reinitiation was associated with lower all-cause costs due to lower biologic use; however, two of these patterns were still associated with significantly higher non-biologic costs. Future research aimed at understanding the sources of non-biologic costs and the impact of different treatment patterns on health outcomes in patients with psoriasis is needed.