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Real-World Claims Analyses of Comorbidity Burden, Treatment Pattern, Healthcare Resource Utilization, and Costs in Pediatric Psoriasis

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Abstract

Introduction

There are limited real-world data on treatment patterns, comorbidities, and healthcare burden in pediatric patients with psoriasis. We examined patient demographics, comorbidity burden, treatment patterns, and healthcare use and costs in pediatric psoriasis.

Methods

A retrospective, real-world, exploratory study was conducted using US claims databases. Pediatric patients aged < 18 years with newly diagnosed psoriasis (index date) were selected from IBM® MarketScan® databases (2016–2018). Patients were enrolled continuously for ≥ 12 months pre- and post-index date. Pre-index demographics, comorbidity, treatment drug classes prescribed, and post-index healthcare resource utilization and costs were studied. Study measures are reported for total population and by severity (categorized as mild and moderate-to-severe psoriasis). Variables were compared using t-test (continuous) or chi-square and Fisher’s exact test (categorical).

Results

Overall, 4754 pediatric patients with psoriasis (58.3% females) met the selection criteria and were included in the study. Mean and standard deviation (SD) age was 12.6 (3.7) years on index date, with 13.4% patients having moderate-to-severe psoriasis. The mean (SD) Deyo-Charlson Comorbidity Index was 0.14 (0.40); anxiety (6.6%), depression (4.1%), and obesity (3.9%) were the most prevalent comorbidities observed. Topical treatments were prescribed to most patients as first-line treatment of mild (79.1%) and moderate-to-severe (52.0%) psoriasis. Other first-line therapies prescribed in moderate-to-severe cases included non-biologic systemics (21.0%), phototherapy (15.0%), and biologics (9.2%). Healthcare use and costs increased with psoriasis severity during the post-index period. Mean annual total all-cause costs per patient were higher for patients with moderate-to-severe psoriasis compared with mild psoriasis ($27,541 vs. $5,034; P < 0.001).

Conclusions

Psychiatric, metabolic, and inflammatory disorders were observed comorbidities in pediatric patients with psoriasis. For moderate-to-severe psoriasis, topicals, phototherapy, and biologics were a common first-, second-, and third-line treatment sequence. Higher unadjusted healthcare costs by severity were driven by outpatient prescription costs.

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Acknowledgements

Funding

This research and Rapid Service and Open Access Fees were funded by Eli Lilly and Company.

Medical Writing Assistance Editorial, and Other Assistance

The authors would like to acknowledge Amy Paller, MD, for her contribution towards the study review and interpretation of results. Minal Jaggar, PhD, an employee of Eli Lilly Services India Pvt. Ltd., provided medical writing support at the time of manuscript preparation. Uma Jyothi Kommoju, PhD, an employee of Eli Lilly Services India Private Limited, provided writing support at the time of revision of the manuscript.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Author Contributions

Emily Edson-Heredia and Seth Anderson contributed to the concept and design of the study. Seth Anderson, Jiaying Guo, William Malatestinic, and Elizabeth Swason contributed to the data analysis. Emily Edson-Heredia, Seth Anderson, Jiaying Guo, Baojin Zhu, and Lara Wine-Lee contributed to the interpretation of the data. Seth Anderson and William Malatestinic contributed to drafting of the manuscript. Emily Edson-Heredia, Seth Anderson, Jiaying Guo, Baojin Zhu, Lara Wine-Lee, Elizabeth Swason, and William Malatestinic contributed to the critical revision of the manuscript.

Compliance with Ethics Guidelines

No human subjects were directly involved, precluding the requirement for internal review board approval.

Disclosures

Emily Edson-Heredia, Jiaying Guo, Baojin Zhu, and William N. Malatestinic are current employees and/or minor stockholders of Eli Lilly and Company. Seth Anderson was a former employee of Eli Lilly and Company and is a current employee of GlaxoSmithKline. Lara Wine-Lee has received grants from and is on the advisory boards for Eli Lilly and Company and AbbVie and has received grants from Celgene. ES has been a speaker for Almirall, Amgen, Eli Lilly and Company, Janssen, Ortho Dermatologics, Pfizer, and Sanofi-Regeneron and has been on advisory boards for Cassiopea, Eli Lilly and Company, Janssen, Ortho Dermatologics, and Sanofi-Regeneron. Part of the study results was presented at the Society of Pediatric Dermatology virtual conference 2020 and 8th Pediatric Dermatology Research Alliance (PeDRA) Annual Conference 2020 held virtually.

Data Availability

All data generated or analyzed during this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA

    Emily Edson-Heredia, Seth Anderson, Jiaying Guo, Baojin Zhu & William N. Malatestinic

  2. Department of Dermatology and Pediatrics, Medical University of South Carolina, Charleston, SC, USA

    Lara Wine-Lee

  3. St. Luke’s Children’s Hospital, Boise, ID, USA

    Elizabeth Swanson

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  1. Emily Edson-Heredia
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  2. Seth Anderson
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Corresponding author

Correspondence to Emily Edson-Heredia.

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Edson-Heredia, E., Anderson, S., Guo, J. et al. Real-World Claims Analyses of Comorbidity Burden, Treatment Pattern, Healthcare Resource Utilization, and Costs in Pediatric Psoriasis. Adv Ther 38, 3948–3961 (2021). https://doi.org/10.1007/s12325-021-01795-7

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