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For Psoriatic Arthritis, Index OSMs Linked With Lower Costs but More Treatment Modifications

September 17, 2020

While the majority of patients initiating pharmacologic treatment for psoriatic arthritis started with oral small molecule (OSM) monotherapy, mediation persistence was poorer, and treatment modifications more common, with index OSMs compared with index tumor necrosis factor inhibitors (TNFis), according to an administrative claims analysis published in The American Journal of Managed Care. 

“Most patients were initially prescribed monotherapy with the least expensive medications for psoriatic arthritis,” researchers reported, “despite evidence suggesting that TNFis may be more cost-effective than OSMs and recommendations for using TNFis as first-line therapy by the most recent treatment guidelines.” 

The observational, retrospective study included 3491 treatment-naïve patients with active psoriatic arthritis from the IBM MarketScan Research databases. Researchers analyzed 12-month treatment patterns and healthcare costs for inpatient and outpatient care, including outpatient prescription costs. 

The initial treatment for psoriatic arthritis was most commonly methotrexate monotherapy; 58.3% of patients began with the OSM, according to the study. Meanwhile, 24.2% began with TNFi monotherapy. 

Medication persistence ranged from 15.2% to 34.6% with OSM monotherapy, compared with 42.9% to 58.2% with TNFi monotherapy. Medication gaps of at least 60 days were more common with OSMs, affecting 42.9% to 48.5% of patients taking OSMs compared with 17.9% to 29.9% of patients taking TNFis.

Analysis showed average healthcare costs were lower with OSMs. Average per-patient per-month total healthcare costs ranged from $1029 to $1456, and average total healthcare costs ranged from $19,173 to $25,013, with OSMs. Average per-patient per-month total healthcare costs ranged from $4203 to $7063, and average total healthcare costs ranged from $45,635 to $60,933, with TNFis.

Low rates of persistence and high rates of gaps with index OSMs likely affected costs associated with the medications, researchers noted. 

“Real-world evidence on medication use by patients may help payers understand the true costs of therapy and healthcare, although variations in dosing, administration, and maintenance schedules across available treatments may complicate these efforts,” researchers concluded. “Studies are warranted to further examine cost-effectiveness of therapies for psoriatic arthritis and their effect on overall healthcare costs.”

Jolynn Tumolo 


Maksabedian Hernandez EJ, Tkacz J, Lopez-Gonzalez L, Higgins K, Ogdie A, Stolshek BS. Psoriatic arthritis treatment patterns and costs among pharmacologic treatment-naïve patients. Am J Manag Care. 2020;26(8):e252-e257. Published 2020 Aug 1. doi:10.37765/ajmc.2020.44075

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