Psoriatic Arthritis Healthcare Costs Continue to Rise Over Time

Thomas R. Collins

August 23, 2021

Editor's note: The headline and parts of this story have been updated to better reflect the study on which it reports.

Annual healthcare costs for patients with psoriatic arthritis (PsA) rose over recent 5-year periods across all categories of resource use to a significantly greater extent than among patients with psoriasis only or those without any psoriatic disease diagnoses, according to commercial insurance claims data.

Using an IBM MarketScan Commercial Database, researchers examined claims data for 208,434 patients with psoriasis, 47,274 with PsA, and 255,708 controls who had neither psoriasis nor PsA. Controls were matched for age and sex. Those with rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, or ulcerative colitis were excluded.

The investigators examined data for 2009 through 2020, following patients for 5 years within that period. They looked at hospitalizations, outpatient and pharmacy services, lab services, and office visits, said Steven Peterson, director of market access for rheumatology at Janssen Pharmaceuticals, during his presentation of the data at the Pan-American League of Associations for Rheumatology (PANLAR) 2021 Annual Meeting, recently held as a virtual event.

The study was also published online May 2 in Clinical Rheumatology.

Large differences between the groups were seen in the first year, when average healthcare costs for the PsA group were $28,322, about half of which were outpatient drug costs. That compared to $12,039 for the psoriasis group and $6,672 for the control group.

The differences tended to widen over time. By the fifth year, average costs for the PsA group were $34,290, nearly 60% of which were drug costs. That compared to $12,877 for the psoriasis group and $8,569 for the control group. In each year examined, outpatient drug costs accounted for less than half of the expenses for the psoriasis group and about a quarter for the control group.

Researchers found that the PsA group needed 28.7 prescriptions per person per year, compared to 17.0 and 12.7 in the psoriasis and control groups, respectively, Peterson said. He also noted that patients with PsA and psoriasis tended to have higher rates of hypertension, depression, and anxiety.

"The cost and resource utilization disparity between these patient groups demonstrates the high remaining unmet medical need for patients with psoriasis and psoriatic arthritis," Peterson said during the virtual proceedings.

Do Findings Reflect Treatment Advances?

Dr Elaine Husni

Elaine Husni, MD, MPH, director of the Arthritis and Musculoskeletal Center at the Cleveland Clinic in Ohio, where she studies health outcomes in PsA, said the findings are helpful in pointing to a trend across a large sample. But she added it's important to remember that the increasing costs could reflect recent advances in PsA treatment, which include costly biologic drugs.

"There's a ton more treatments for psoriasis and psoriatic arthritis than there were even just 5 years ago," she told Medscape Medical News in an interview. She was not involved with the research.

Husni would like to see a more detailed look at the costs, from the categories of expenses to the patients who are incurring the highest costs.

"Is it just a couple of percent of really sick patients that are driving the psoriatic arthritis group?" she wondered.

She also pointed out that PsA is going to be more expensive by its very nature. PsA tends to develop 3-10 years after psoriasis, adding to the costs for someone who already has psoriasis and at a time when they are older and likely have higher healthcare costs due to comorbidities that develop with age.

Husni said she does think about treatment costs, in that a less expensive first-line drug might be more appropriate than going straight to a more expensive biologic, especially because they also tend to be safer. She said it's not just a simple question of curbing costs.

"Is there a way that we can personalize medicine?" she asked. "Is there a way that we can be more accurate about which people may need the more expensive drugs, and which patients may need the less expensive drugs? Are we getting better at monitoring so we can avoid high-cost events?"

Peterson is an employee of Janssen Pharmaceuticals. Husni has reported serving as a consultant for AbbVie, Amgen, Bristol-Myers Squibb, UCB, Novartis, Lilly, and Pfizer.

PANLAR 2021 Annual Meeting. Presented August 14, 2021.

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