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

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.