Dose escalation and associated economic outcomes in patients with psoriasis treated with biologics: a retrospective analysis of German health claims data.

IF 3.7 4区 医学 Q1 DERMATOLOGY
Andreas Pinter, Ahmed M Soliman, Karina C Manz, Valeria Weber, Paul Ludwig, Anja Mocek, Ariane Höer, Sven G Richter, Mark G Lebwohl
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引用次数: 0

Abstract

Background: In Germany, several biologic therapies are available for the treatment of moderate-to-severe plaque psoriasis, with the option of exceeding recommended dosages if standard dosing does not achieve a satisfactory treatment response.

Objectives: To examine dose escalation in patients with biologic-treated psoriasis and its implications on the costs for German statutory health insurance (SHI).

Methods: We conducted a retrospective, noninterventional cohort study using German SHI health claims data from 2016 to 2021. Adult patients initiating biologic treatment were included in drug-specific cohorts. The odds for dose escalation, defined as the exceedance of the individually received daily dose over the maintenance dose recommended by the European product information, were compared between cohorts using multivariate logistic regression. The impact of dose escalation on SHI expenditure was analysed with a generalized linear model.

Results: The relative frequency of dose escalation varied between cohorts [range 1%, < 5/92 (risankizumab) to 43%, < 5/7 (infliximab)]. Compared with patients treated with risankizumab, the odds for dose escalation were statistically significantly (P < 0.05) higher in patients treated with all other biologic drugs except tildrakizumab. Patients with dose escalation during the maintenance phase accrued on average €6473 more in direct healthcare costs to SHI over a 1-year period compared with those without dose escalation, with statistical significance (P < 0.05) after controlling for differences in covariates.

Conclusions: Compared with patients treated with other biologics, dose escalation during the maintenance phase was lowest among patients treated with risankizumab. Dose escalation was associated with higher costs and thus a higher economic burden for German SHI.

接受生物制剂治疗的银屑病患者的剂量升级和相关经济后果:对德国医疗索赔数据的回顾性分析。
背景:在德国,有几种生物疗法可用于治疗中度至重度斑块状银屑病,如果标准剂量不能达到满意的治疗效果,可选择超过推荐剂量:研究生物制剂治疗银屑病患者的剂量升级以及德国法定医疗保险(SHI)的相关费用发展:我们利用德国法定医疗保险(SHI)2016 年至 2021 年的健康索赔数据开展了一项回顾性、非干预性队列研究。开始接受生物制剂治疗的成年患者被纳入特定药物队列。使用多变量逻辑回归法比较了不同队列之间发生剂量升级的几率,剂量升级的定义是个人每日接受的剂量超过欧洲产品信息推荐的维持剂量。采用广义线性模型分析了剂量升级对 SHI 支出的影响:结果:不同队列之间剂量升级的相对频率各不相同(从1.1%[利桑珠单抗]到42.9%[英夫利昔单抗]不等)。与利桑珠单抗治疗的患者相比,除替曲单抗外,所有其他生物制剂治疗的患者出现剂量升级的几率在统计学上明显更高(P < 0.05)。与未进行剂量升级的患者相比,在维持治疗阶段进行剂量升级的患者在一年内向社会保险局支付的直接医疗费用平均增加了6,473欧元,在控制了协变量的差异后,差异具有统计学意义(p < 0.05):与接受其他生物制剂治疗的患者相比,接受利桑珠单抗治疗的患者在维持治疗阶段的剂量增加最少。剂量升级与较高的费用有关,因此对德国社会保险局造成了较高的经济负担。
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来源期刊
CiteScore
3.20
自引率
2.40%
发文量
389
审稿时长
3-8 weeks
期刊介绍: Clinical and Experimental Dermatology (CED) is a unique provider of relevant and educational material for practising clinicians and dermatological researchers. We support continuing professional development (CPD) of dermatology specialists to advance the understanding, management and treatment of skin disease in order to improve patient outcomes.
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