title: Medication adherence and health care costs associated with biologics in Medicaid-enrolled patients with psoriasis.
abstract: BACKGROUND
  Costs and patients' adherence related to biologics are important factors to consider while making informed decisions regarding therapy with biologics in psoriasis management.
  
  
  OBJECTIVE
  To examine predictors of adherence related to biologics, total health care costs, and service utilization among psoriasis patients.
  
  
  METHODS
  This was a longitudinal cohort study of psoriasis patients (<65 years old) enrolled in North Carolina Medicaid who were prescribed biologics (alefacept, efalizumab, and etanercept). Patients' medication adherence, health care costs, and service utilization patterns in the pre- and post-biologics period were examined.
  
  
  RESULTS
  Adherence to biologics was significantly higher compared with the other psoriasis medications (0.66 vs 0.39; p<0.001). Prescription costs were significantly higher in the post-biologics period (3796.77 US dollars vs 11,706.32 US dollars; p<0.001). However, total health care costs in the post-biologics period did not differ significantly from the pre-biologics period (14,662.22 US dollars vs 16,156.10 US dollars; p>0.05). Patients' adherence and health care costs did not differ significantly across the biologics. After controlling for other variables, patients had a significantly lower number of hospitalizations in the post-biologics period (p<0.001).
  
  
  CONCLUSIONS
  Although costs associated with prescriptions for biologics were higher, total health care costs did not differ significantly in the post-biologics period. Biologics had a better adherence rate compared with other psoriasis medications.
authors.affiliation: Division of Pharmacy Practice and Administration, The Ohio State University College of Pharmacy, Columbus, OH 43210, USA.
authors.forename: Monali J
authors.initials: MJ
authors.lastname: Bhosle
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
authors.forename: Fablan T
authors.initials: FT
authors.lastname: Camacho
authors.forename: J
authors.initials: J
authors.lastname: Timothy Whitmire
authors.forename: Milap C
authors.initials: MC
authors.lastname: Nahata
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
mesh_terms: D000328:Adult; D001688:Biological Products / Q000008:administration & dosage* / Q000191:economics*; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D010349:Patient Compliance; D011565:Psoriasis / Q000191:economics / Q000628:therapy*; D014481:United States
chemical_list: D001688:Biological Products