Original Article

Arthritis Care & Research DOI 10.1002/acr.22492

Economic and Comorbidity Burden among Moderate-to-Severe Psoriasis Patients with Comorbid Psoriatic Arthritis Steven R. Feldman MD PhD1, Yang Zhao PhD2*, Lizheng Shi, PhD3, Mary Helen Tran PharmD2, Jackie Lu PharmD2 INSTITUTIONS: 1. Wake Forest Baptist Medical Center, Winston-Salem, NC, United States 2. Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States 3. Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States * Corresponding author: Yang Zhao Ph.D US Medical and Drug Regulatory Affairs, Novartis Pharmaceuticals Corporation One Health Plaza, East Hanover, NJ 07936-1080 (office) 862-778-3662, (fax) 973-781-2390 [email protected] Word Count: 3, 376 (word limit: 3,800) Figure: 2 Table: 4 Funding Disclosure: This study was sponsored by Novartis Pharmaceuticals Corporation. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as an ‘Accepted Article’, doi: 10.1002/acr.22492 © 2014 American College of Rheumatology Received: Mar 11, 2014; Revised: Sep 12, 2014; Accepted: Sep 30, 2014

Arthritis Care & Research Burden of Psoriasis Patients Comorbid with Psoriatic Arthritis

ABSTRACT Objective: To compare the prevalence of comorbidities, healthcare utilization and costs between moderateto-severe psoriasis (PsO) patients with comorbid psoriatic arthritis (PsA) and matched controls. Methods: Adults aged 18 to 64 years with concomitant diagnoses of PsO and PsA (PsO+PsA) were identified in the OptumHealth Reporting and Insights claims database between January 2007 and March 2012. Moderate-to-severe PsO was defined based on the use of at least one systemic or phototherapy during the 12-month study period after the index date (randomly selected date after the first PsO diagnosis). Control patients without PsO and PsA were demographically matched 1:1 with PsO+PsA patients. Multivariate regressions were employed to examine PsO/PsA-related comorbidities, medications, healthcare utilization and costs between PsO+PsA patients and controls, adjusting for demographics, index year, insurance type, and non-PsO/PsA related comorbidities. Results: Among 1,230 matched pairs of PsO+PsA patients and controls, PsO+PsA patients had significantly more PsO/PsA-related comorbidities, with the top three most common in both groups being hypertension (35.8% vs. 23.5%), hyperlipidemia (34.6% vs. 28.5%), and diabetes (15.9% vs. 10.0%). Compared with controls, PsO+PsA patients had a higher number of distinct prescriptions filled (incidence rate ratio=2.3), were more likely to have inpatient admissions (odds ratio (OR)=1.6), emergency room visits (OR=1.3) and outpatient visits (OR=62.7) (all

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Arthritis Care & Research Burden of Psoriasis Patients Comorbid with Psoriatic Arthritis

p1 or IRRs>1 indicate an increased risk or incidence rates for PsO+PsA patients compared with controls.

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Arthritis Care & Research Burden of Psoriasis Patients Comorbid with Psoriatic Arthritis

Table 4. All-cause medical service utilization in moderate-to-severe PsO+PsA patients and matched controls Odds Ratio, Moderate-to-severe PsO+PsA

Unadjusted Controls

All-cause medical service utilization1

Adjusted Incidence Rate Ratio

P value2

patients

P value4 [95% CI]

(N= 1,230) [A]

(N= 1,230) [B]

[A] vs. [B]

3,4

~[A]/[B]

[A] vs. [B]

Inpatient admissions Any admission, n (%)

133

(10.8%)

Number of admissions, mean (SD)

0.17

(0.64)

Total length (days) of stay, mean (SD)

1.06

Any visit, n (%) Number of visits, mean (SD)

86

(7.0%)

0.0005**

1.6

[1.1; 2.2]

0.0102*

0.10

(0.43)

0.0008**

1.5

[1.1; 2.1]

0.0093**

(5.93)

0.70

(7.08)

0.0015**

2.0

[1.3; 3.2]

0.0222*

264

(21.5%)

212

(17.2%)

0.0086**

1.3

[1.0; 1.6]

0.0322*

0.38

(1.05)

0.28

(0.92)

0.0038**

1.3

[1.0; 1.6]

0.0478*

Emergency room visits

Outpatient visits Any visit, n (%)

1,221

(99.3%)

1,050

(85.4%)