Treatment patterns and healthcare costs among biologic-naive patients initiating apremilast or biologics for the treatment of psoriatic arthritis: results from a US claims analysis

Objective: Information on treatment costs for psoriatic arthritis (PsA) can be valuable for payers and providers who make treatment and formulary decisions. This study compared real-world treatment patterns and healthcare costs among biologic-naive patients with PsA initiating apremilast or biologics. Methods: A retrospective cohort study was conducted using the Optum Clinformatics (TM) claims database. The study included biologic-naive patients with PsA who initiated treatment with apremilast or a biologic between 1 January 2014, and 31 December 2015. Propensity score matching was used to adjust for selection bias. Treatment persistence/adherence and all-cause healthcare costs were evaluated. Cost differences were determined using Wilcoxon rank-sum tests. Results: In all, 125 biologic-naive patients initiating treatment with apremilast were matched to 245 biologic-naive patients initiating treatment with a biologic. Twelve-month treatment persistence was similar for apremilast vs. biologic users (43.2 vs. 36.7%; p = .2277). While persistent on treatment for up to 12 months, total healthcare costs (from all utilizations) were significantly lower among apremilast vs. biologic users ($28,130 vs. $37,093; p < .0001). Likewise, per-patient per-month costs while persistent on treatment were significantly lower among apremilast vs. biologic users whether they switched treatments ($2,455 vs. $3,497; p = .0103), remained persistent on treatment ($2,434 vs. $3,521; p < .0001), or discontinued but did not switch treatments ($2,178 vs. $2,696; p = .0082). Conclusions: Apremilast patients had significantly lower healthcare costs than biologic patients, even when they switched to a biologic, during the 12-month post-index period. These results may be useful to payers and providers seeking to optimize PsA care while reducing healthcare costs.