title: Healthcare resource utilization, healthcare costs and dose escalation in psoriasis patients initiated on ustekinumab versus adalimumab: a retrospective claim study.
abstract: BACKGROUND
  Adalimumab and ustekinumab are effective psoriasis treatments. This study compares healthcare resource utilization (HRU), costs and dose escalation and describes starting dose trends in ustekinumab versus adalimumab psoriasis patients.
  
  
  METHODS
  Adult psoriasis patients initiating adalimumab/ustekinumab on/after 25 September 2009 were selected from a US claims database and classified into biologic-naïve and biologic-experienced samples.
  
  
  RESULTS
  A total of 602 ustekinumab and 3470 adalimumab biologic-naïve and 1193 ustekinumab and 1467 adalimumab biologic-experienced patients were included. In both samples, ustekinumab patients had significantly more days with medical services (biologic naïve: IRR =1.14; biologic experienced: IRR =1.08) and higher average total costs by more than $14,000 annually. Ustekinumab users were 2.6 and 1.9 times more likely to have a dose escalation (increase ≥45 mg in ustekinumab; ≥40 mg in adalimumab) in biologic-naive and biologic-experienced patients, respectively. Between S2/2009 and S1/2012, the proportion of patient initiating on high dose (ustekinumab: >45 mg/28 days; adalimumab: >160 mg/28 days) increased substantially for ustekinumab patients (biologic naïve: +18.6 percentage points [PP]; biologic experienced: +29.9 PP) but remain stable for adalimumab patients (biologic naïve: -0.3 PP; biologic experienced: +2.3 PP).
  
  
  CONCLUSIONS
  Ustekinumab patients had more HRU, higher total costs and were more likely to have a dose escalation. The proportion of patients initiating ustekinumab high dose increased substantially between 2009 and 2012.
authors: a Kaiser Permanente Los Angeles Medical Center , Los Angeles , CA , USA.
authors: Jashin J
authors: JJ
authors: Wu
authors: b Analysis Group, Inc , Montreal , QC , Canada.
authors: Annie
authors: A
authors: Guérin
authors: b Analysis Group, Inc , Montreal , QC , Canada.
authors: Geneviève
authors: G
authors: Gauthier
authors: c Health Economics and Outcomes Research, AbbVie , North Chicago , IL , USA.
authors: Murali
authors: M
authors: Sundaram
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011565:Psoriasis / Q000188:drug therapy* / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome; D000069549:Ustekinumab / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D000069549:Ustekinumab; D000068879:Adalimumab
keywords: Health expenditures; anti-inflammatory agent; drug costs; economics; medical care costs; monoclonal antibody