Pinter Andreas, Schulte Marcus, Kossack Nils, Pignot Marc, Schultze Michael, Feldhus Andrea
Department of Dermatology, Venereology and Allergology, Goethe University Hospital Frankfurt, Frankfurt, Germany.
Amgen GmbH, Munich, Germany.
J Med Econ. 2025 Dec;28(1):207-220. doi: 10.1080/13696998.2025.2452054. Epub 2025 Jan 21.
Psoriasis is a chronic, systemic, inflammatory skin disease, with increasing prevalence; however, few studies have reported real-world prescription patterns and healthcare burden.
This retrospective, observational cohort study used statutory health insurance claims data (January 2014-December 2019) to estimate prevalence/incidence of moderate-to-severe psoriasis in Germany. Patient characteristics, treatment patterns/compliance, and healthcare resource utilization (HCRU)/costs were evaluated, focusing on apremilast and anti-interleukin (IL), and anti-tumor necrosis factor (TNF) biologics.
The epidemiology population included adults with psoriasis; 1-year prevalence/incidence rates were extrapolated to the statutory health insurance population. The HCRU/costs population included adults with psoriasis and a first prescription for a drug of interest (index date). Baseline periods were 12 or 48 months before the index date, with 12‑month follow-up.
In 2019, the estimated psoriasis prevalence/incidence was 2,672.9 per 100,000 individuals/508.7 per 100,000 person-years. Of 2,809 patients in the HCRU/costs population, 3.6% ( = 101) received index drug apremilast, 10.2% ( = 287) anti-IL, 6.8% ( = 191) anti-TNF, and 79.4% ( = 2,230) traditional/other systemic therapy. Patients initiating apremilast were older and were more often biologic-naïve than those initiating anti-IL/TNF biologics. Twelve months after treatment initiation, drug adherence (medication possession rate >80%) and persistence (<60 days between prescriptions/no switch) were lower for apremilast anti-IL and anti-TNF groups (24.8% 59.6% and 53.9%; 36.6% 66.9% and 57.6%, respectively). During a 12-month baseline period, psoriasis-related hospitalization was lower for apremilast anti-IL and anti-TNF groups (4.95% 15.68% and 14.14%) and higher during 12 months' follow-up (5.94% 2.44% and 3.14%). Adjusted index drug costs during follow-up were €4,105, €3,498, and €13,777 higher for adalimumab, other anti-TNF and anti-IL biologics apremilast, respectively, and the main driver for lower overall apremilast costs.
Given variation in treatment adherence/persistence, HCRU, and costs between apremilast and biologics, these findings could be key considerations during treatment selection.
银屑病是一种慢性、全身性炎症性皮肤病，患病率呈上升趋势；然而，很少有研究报告实际的处方模式和医疗负担。
这项回顾性观察队列研究利用法定医疗保险理赔数据（2014年1月至2019年12月）估计德国中重度银屑病的患病率/发病率。评估了患者特征、治疗模式/依从性以及医疗资源利用（HCRU）/成本，重点关注阿普斯特以及抗白细胞介素（IL）和抗肿瘤坏死因子（TNF）生物制剂。
流行病学研究人群包括成年银屑病患者；将1年患病率/发病率外推至法定医疗保险人群。HCRU/成本研究人群包括成年银屑病患者以及首次开具感兴趣药物处方（索引日期）的患者。基线期为索引日期前12个月或48个月，并进行12个月的随访。
2019年，估计银屑病患病率/发病率分别为每10万人2672.9例/每10万人年508.7例。在HCRU/成本研究人群的2809例患者中，3.6%（n = 101）接受了索引药物阿普斯特，10.2%（n = 287）接受抗IL治疗，6.8%（n = 191）接受抗TNF治疗，79.4%（n = 2230）接受传统/其他全身治疗。开始使用阿普斯特的患者比开始使用抗IL/TNF生物制剂的患者年龄更大，且更常为初治患者。治疗开始12个月后，阿普斯特组的药物依从性（药物持有率>80%）和持续性（两次处方之间间隔<60天/未换药）低于抗IL和抗TNF组（分别为24.8%、59.6%和53.9%；36.6%、66.9%和57.6%）。在12个月的基线期内，阿普斯特组银屑病相关住院率低于抗IL和抗TNF组（4.95%、15.68%和14.14%），而在12个月随访期间更高（5.94%、2.44%和3.14%）。随访期间，阿达木单抗、其他抗TNF和抗IL生物制剂组的调整后索引药物成本分别比阿普斯特组高4105欧元、3498欧元和1377欧元，这是阿普斯特总体成本较低的主要原因。
鉴于阿普斯特与生物制剂在治疗依从性/持续性、HCRU和成本方面存在差异，这些发现可能是治疗选择过程中的关键考虑因素。
