Dermatology Research and Education Foundation, Irvine, CA, USA.
Celgene Corporation, 86 Morris Avenue, Summit, NJ, 07901, USA.
Adv Ther. 2020 May;37(5):2098-2115. doi: 10.1007/s12325-020-01262-9. Epub 2020 Mar 5.
We compared treatment switch patterns and healthcare costs among biologic-naive patients with psoriatic arthritis (PsA) who initiated apremilast or biologics.
A 1:2 propensity score match was used to adjust administrative claims data for adults initiating apremilast or biologics from January 1, 2014, to September 30, 2016, for possible selection bias. Patients had at least 12 months of pre- and post-index continuous enrollment in the Optum Clinformatics™ Data Mart database. Outcomes included switch frequency, days to switch, adherence on index treatment, and healthcare costs (total and per patient per month). Switch rate was defined as the proportion of patients who switched to a new treatment after initiation of the index treatment, and days to switch was calculated as the days between initiation of the index treatment and initiation of the new treatment. Adherence was calculated using the proportion of days covered and the medication possession ratio. The t test and chi-square, Kaplan-Meier, and Wilcoxon rank-sum tests were used to evaluate differences between the cohorts.
Patient characteristics and switch rates were similar between the matched apremilast (n = 170) and biologic (n = 327) cohorts. After matching, patient characteristics were similar between the matched cohorts. The 12-month switch rates were similar for patients initiating apremilast versus those on biologics (17.7% vs. 25.1%, P = 0.06). This trend was similar at 6 months (7.7% vs. 13.2%, P = 0.07) and 18 months (24.4% vs. 29.3%, P = 0.33). Regardless of treatment switching, 12-month total healthcare costs were lower with apremilast versus biologics (all: $28,423 vs. $41,178, P < 0.0001; switched: $39,803 vs. $51,517, P = 0.0040; did not switch: $25,984 vs. $37,717, P < 0.0001).
Biologic-naive patients with PsA who initiated apremilast had switch rates similar to biologic users and significantly lower healthcare costs, regardless of treatment switching.
我们比较了生物制剂初治银屑病关节炎（PsA）患者起始使用阿普司特或生物制剂的治疗转换模式和医疗保健费用。
使用倾向评分 1:2 匹配法，调整了 2014 年 1 月 1 日至 2016 年 9 月 30 日接受阿普司特或生物制剂治疗的成年人的行政索赔数据，以消除选择偏倚。患者在 Optum Clinformatics™ Data Mart 数据库中至少有 12 个月的索引前和索引后连续入组。结果包括转换频率、转换天数、索引治疗的依从性以及医疗保健费用（总费用和每位患者每月费用）。转换率定义为起始索引治疗后转换为新治疗的患者比例，转换天数为起始索引治疗和起始新治疗之间的天数。依从性使用比例和药物维持率来计算。使用 t 检验、卡方检验、Kaplan-Meier 检验和 Wilcoxon 秩和检验来评估队列之间的差异。
匹配的阿普司特（n=170）和生物制剂（n=327）队列之间的患者特征和转换率相似。匹配后，匹配队列的患者特征相似。起始阿普司特治疗的患者 12 个月的转换率与起始生物制剂治疗的患者相似（17.7%比 25.1%，P=0.06）。这一趋势在 6 个月（7.7%比 13.2%，P=0.07）和 18 个月（24.4%比 29.3%，P=0.33）时相似。无论是否发生治疗转换，起始阿普司特治疗的患者 12 个月的总医疗保健费用均低于生物制剂治疗（所有患者：$28423 比$41178，P<0.0001；发生转换：$39803 比$51517，P=0.0040；未发生转换：$25984 比$37717，P<0.0001）。
生物制剂初治银屑病关节炎患者起始使用阿普司特的转换率与生物制剂使用者相似，且无论是否发生治疗转换，其医疗保健费用均显著降低。
