Costs of DMARDs and Methotrexate for Psoriatic Arthritis

Washington, DC—Retrospective data from a study conducted to describe healthcare costs associated with the management of psoriatic arthritis (PsA) in patients newly initiated on a biologic therapy or methotrexate (MTX) found that the average annual total healthcare cost is largely driven by PsA-related healthcare costs, of which pharmacy costs account for most of the cost.

The findings were presented during a poster session at the ACR meeting. The poster was titled Healthcare Costs in Psoriatic Arthritis Patients Newly Initiated on a Biologic Disease-Modifying Anti-Rheumatic Drug or Methotrexate.
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Using data from the US-based Thomson Reuters MarketScan^® Research database between 2005 and 2009, the authors identified a sample of patients who met specific criteria and were initiated on either biologic therapy (n=3263) or MTX (n=1217). All patients included in the sample had ≥2 PsA diagnoses over the entire period of the database, were new users of a biologic or MTX, did not have a diagnosis of ankylosing spondylitis, had ≥2 PsA diagnoses from physician office visits over the 18-month observation period and ≥1 diagnoses from an office visit during the 6-month period after the index data, were ≥18 years of age, and were continuously enrolled for ≥6 months before and ≥12 months after the index date.

Baseline characteristics of the patients included average age of 49 and 50 years in patients treated with biologic therapy and those treated with MTX, respectively, with the females comprising the majority in each group (53.2% and 54.0%, respectively). The most prevalent comorbidities in both cohorts were rheumatoid arthritis, hypertension, diabetes, hypothyroidism, chronic pulmonary disease, and deficiency anemias. More than 60% of patients in both cohorts were seen by a rheumatologist during the baseline period, and patients had an average of 10 outpatient visits for the biologic cohort and 9 outpatient visits for the MTX cohort over 6 months. Overall, the average total healthcare cost at baseline was $2476 for the biologic cohort and $5283 for the MTX cohort.

Frank Zhang, MD, the study’s lead author and an employee of Celgene Corporation, said the study found that the average annual total healthcare cost of treating patients with PsA was $30,282 after initiation of a biologic therapy and $14,329 after initiation of MXT, which was largely driven by PsA-related healthcare costs that accounted for 67.5% of costs for biologic therapy and 42.3% of costs for MTX.

The study also found that pharmacy costs accounted for 55.7% of all healthcare costs and 92.7% of PsA-related costs for the biologic cohort and 40.2% of all healthcare costs and 80.4% of PsA-related costs in patients treated with MTX. Of the remaining PsA-related costs that contributed to the cost burden of PsA, most came from office care and monitoring.

Limitations of the study, according to Dr. Zhang, included using data based on healthcare claims because of the potential for error and omission. In addition, healthcare claims did not indicate disease severity, and therefore the costs assessed were not able to measure the effect that disease severity could have had on management of PsA.

This study was supported by Celgene Corporation.