Retrospective Real-World Comparison of Adherence, Persistence, Health-Care Utilization, and Costs Among Biologics for Moderate-to-Severe Psoriasis in China.

BACKGROUND AND OBJECTIVES: Biologics have significantly enhanced treatment for psoriasis but data regarding their treatment patterns and economic burden are limited. The aim of this study was to evaluate adherence, persistence, switching, health-care resource utilization (HCRU) and costs among secukinumab, adalimumab, ustekinumab, and ixekizumab in China. METHODS: This retrospective observational study identified adult patients with psoriasis who initiated biologics between 1 January 2020 and 30 June 2022, from the Regional Medical Big Data of Tianjin, China (comprising hospital information system data from 43 tertiary and 39 secondary hospitals). Treatment adherence was assessed using the Proportion of Days Covered (PDC) and PDC ≥ 80% was defined as adherence. Persistence was defined as continuous use of the index biologic without a gap > 180 days between consecutive prescriptions until end of follow-up. Psoriasis-related and all-cause health-care utilization and direct medical costs (Chinese Yuan, ¥) were assessed over a 1-year follow-up period. RESULTS: A total of 1646 patients (mean age 43.7 ± 14.0 years; 67.0% male) were included of whom 1306, 182, 98, and 60 initiated treatments with secukinumab, adalimumab, ustekinumab, and ixekizumab, respectively. Patient medication adherence decreased over time. At 12 months, ustekinumab and ixekizumab had similar persistence rates (65.9% and 64.7%, P = 0.588), while secukinumab and adalimumab had lower rates (32.3% and 17.9%, respectively, P < 0.001). Only 3.0% of the overall patients switched to second-line therapy. Patients treated with secukinumab and adalimumab more frequently used outpatient services (95.6% and 99.5% visited annually, P < 0.001), while a higher proportion of ustekinumab and ixekizumab patients were hospitalized (81.6% and 83.3%, respectively, P < 0.001). The annual costs were highest for patients initiated with ustekinumab (¥22,727 ± 11,028), followed by secukinumab (¥20,037 ± 13,369), driven by the drug costs of biologics. CONCLUSIONS: This study suggests that ustekinumab and ixekizumab are associated with better adherence and persistence compared with secukinumab and adalimumab. Ustekinumab and ixekizumab are primarily used during hospitalization, possibly owing to their high unit price or low injection frequency. Cost-effective treatment options that enhance treatment adherence and persistence are required.