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Comparative Treatment Patterns Among Psoriasis Patients Using Adalimumab, Etanercept, or Ustekinumab

This retrospective study compared the treatment patterns of ustekinumab with recommended maintenance administration every 12 weeks, with adalimumab and etanercept, administered weekly or every other week, for the treatment of plaque psoriasis.
Published Online: Oct 18,2016
Chureen Carter, PharmD, MS; Kathleen L. Wilson, MPH; David Smith, PhD; and Seina Lee, PharmD, MS
Data Source

This retrospective analysis used the Truven Health MarketScan Commercial Claims and Encounters and Medicare Supplemental Databases, which contain administrative healthcare claims for inpatient and outpatient medical and outpatient pharmacy services. Individuals in the databases are insured through a variety of private health plans, including preferred provider organizations, indemnity plans, and health maintenance organizations.

The Medicare database contains claims for individuals insured through Medicare supplemental commercial insurance. Both Medicare-covered and insurer-covered services are included due to coordination of benefits. These databases include enrollment data from approximately 150 large employers and health plans across the United States, which provide private healthcare coverage and contain more than 60 million covered lives per year.

Data are de-identified and are fully compliant with the Health Insurance Portability and Accountability Act of 1996. As this study did not involve the collection, use, or transmittal of individually identifiable data, it did not require Institutional Review Board review or approval.

Patient Identification
Persons who were included in the analyses were ≥18 years; had ≥1 pharmacy claim for ADA, ETA, or UST, or had ≥1 medical claim for UST, between February 8, 2010, and January 31, 2011 (index date); had at least 12 months of pre- and postindex continuous enrollment in medical and pharmacy benefits; and had at least 1 nondiagnostic claim with a diagnosis of psoriasis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] 696.1) on the index date or during the 12-month pre-index period.

Patients with a diagnosis of any of the following conditions on the index date, or during the 12-month pre-index period, were excluded: rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, Crohn’s disease, ankylosing spondylitis. Patients were selected into 3 mutually exclusive cohorts (ADA, ETA, UST) based the index drug.

Measures Assessed During the 12-month Pre-index Period
The Charlson Comorbidity Index (CCI)21 and individual comorbidities were assessed using the ICD-9-CM codes on nondiagnostic medical claims during the baseline period. Psoriasis treatments were also assessed during the baseline period. Per-patient healthcare expenditures were measured using paid amounts for adjudicated claims. Psoriasis-related expenditures were measured using medical claims with a diagnosis of psoriasis and pharmacy claims for any psoriasis treatment.