Treatment patterns, healthcare resource utilization, and costs in patients with moderate-to-severe psoriasis treated with systemic therapy in Japan: A retrospective claims database study

Abstract

The real-world treatment landscape for patients with moderate-to-severe psoriasis receiving systemic therapies in Japan is not well understood. This study describes the demographic and clinical characteristics, treatment patterns, healthcare resource utilization, and psoriasis-associated costs in these patients. This retrospective observational study used data from the Japan Medical Data Center database between January 2016 and December 2020. Eligible patients had a confirmed diagnosis of psoriasis, ≥1 claim for a systemic treatment of interest, medical history for ≥6 months, and follow-up data for ≥12 months. Systemic therapies comprised biologics (tumor necrosis factor and interleukin inhibitors) and oral treatments (a phosphodiesterase-4 inhibitor, immunosuppressants, and vitamin A). Patient demographics and clinical characteristics, treatment patterns, healthcare resource utilization, and costs were evaluated. The study identified 1770 patients satisfying all inclusion criteria. The mean age was 49.0 years, with 68% of patients aged 20-54 years. Overall, 90.6% and 9.4% of patients received oral medications and biologics as index treatment, respectively. Treatment patterns, healthcare resource utilization, and costs were assessed for treatments received by ≥20 patients (n = 1730). During the 12-month follow-up period, 1102/1730 patients (63.7%) discontinued index treatment, of whom 9.9% switched to alternative systemic treatments. The persistence rate was ≥70% for most biologics and <50% for oral systemic treatments. All 1730 patients had ≥1 all-cause outpatient visit (2.0 visits per person per month) and hospitalization frequency was ≤0.01 per person per month. Persistent patients incurred inflation-adjusted costs of Japanese Yen (JPY) 88 667 per person per month. Treatment switching was associated with an increase in total cost: JPY 128 039 per person per month after switching versus JPY 117 504 before switching. This study of Japanese patients with moderate-to-severe psoriasis demonstrated low persistence, high discontinuation, and low rates of treatment switching with systemic therapies. Switching was associated with increased total cost. These results indicate unmet needs for new treatments.

Keywords: cost of illness; health resources; medication adherence; practice patterns; psoriasis.

FIGURE 1

Patient disposition. ICD‐10, International Classification of Diseases 10th Revision; JMDC, Japan Medical Data Center; n, number of patients; PsO, psoriasis.

FIGURE 2

Persistence at 12 months by individual medication. (a–c) Persistence rate for patients receiving oral systemic treatments and (d–h) persistence rate for patients receiving biologics. CI, confidence interval; n, number of patients; NR, not reached.

FIGURE 3

Cost associated with persistence and switching. (a) Cost for patients persisting on index treatment for 12 months and (b) cost for patients who switched to other treatments in the 12‐month follow‐up period. IL, interleukin; JPY, Japanese Yen; n, number of patients; PDE‐4, phosphodiesterase‐4; PPPM, per person per month. ^†Includes biologics received by < 20 patients. Error bars indicate 95% confidence intervals.