VBCR - August 2012, Volume 1, No 3 - Psoriatic Arthritis

By David Hawk

Berlin, Germany—Results of an analysis presented by Chureen T. Carter, PharmD, MS, Associate Director of Health Economics and Outcomes Research at Janssen Scientific Affairs, Horsham, PA, and colleagues at the 2012 European League Against Rheumatism Congress indicate that during the time period of the introduction of biologic agents for the treatment of psoriatic arthritis, the direct healthcare costs related to psoriatic arthritis management rose from approximately $3500 annually to an annual expenditure exceeding $16,000.

“This estimate of new economic burden of illness estimate may further aid decision makers in assessing the cost-effectiveness and budgetary impact of psoriatic arthritis therapies, including biologics,” noted Dr Carter.

Previous estimates of the annual direct (ie, inpatient, outpatient, and pharmacy) costs per patient with psoriatic arthritis had been $3500 in the United States. However, this estimate is a decade old and does not account for new biologic treatments, advances in diagnostic procedures, or updated reimbursement policies. Data describing the current economic burden of psoriatic arthritis in the United States are limited.

In the present analysis, investigators from Janssen focused on direct psoriatic arthritis costs in a population of patients with evidence of receiving the company’s biologic drug golimumab (Simponi), which was approved by the US Food and Drug Administration in 2009 for the treatment of psoriatic arthritis. The costs associated with psoriatic arthritis included those incurred during the 2-year period before initiating golimumab.

Using data from the IMS LifeLink Health Claims database, the research­ers identified patients who had initi­ated treatment with golimumab be­tween April 2009 and June 2010.

The study included 211 patients (average age, 50 years) with psoriatic arthritis who received a prescription for golimumab; 61% were female, and concomitant diagnosis codes for rheumatoid arthritis were found for 39.8% of the patients. Of note, 180 of these patients had already received treatment before the introduction of golimumab.

A cost-estimate analysis of psoriatic arthritis management before the availability of biologic agents showed direct healthcare costs ranging from $3500 to $9200 annually. However, as expected, a more recent cost estimate representing a 2-year period before patients began using golimumab, revealed that costs have risen dramatically to $16,369 annually.

This increased financial burden to the payer is significant, but as the researchers pointed out, “This estimate should be considered in the context of incremental improvements in clinical outcomes associated with biologic treatments as compared with older psoriatic arthritis therapies.”

An Expense versus an Investment

A new study looked not only at the direct costs of managing patients with psoriatic arthritis but at the in­direct costs as well (Kvamme MK, et al. Rheumatology [Oxford]. 2012;51: 1618-1627).

Direct costs included pharmaceuticals, imaging examinations, inpatient and outpatient care, rehabilitation unit stays, and visits to general practitioners, private rheumatologists, and physiotherapists. Indirect costs includ­ed patients’ work absenteeism.

The data for this analysis were de­rived from 1700 patients being treated within the Norwegian healthcare system, a source that captures outcomes and resource use among patients.

As with the previous study, the annual direct costs, including the use of biologic treatments, were substantial, exceeding €32,000 annually. How­ever, in this analysis the researchers stressed that the largest cost component of the total costs was the loss of patient productivity (ie, the indirect costs).

An analysis of the entire data set, however, sheds some encouraging light. Describing trends over 2 years, the researchers stated, “Total costs decreased significantly from the first to the fourth 6-month periods, and this decrease was influenced by reductions in both direct and indirect costs.” Simply put, drugs that are effective put patients back on the job.

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