Applied Health Economics and Health Policy

, Volume 10, Issue 5, pp 343–353

Work Productivity and Healthcare Resource Utilization Outcomes for Patients on Etanercept for Moderate-to-Severe Plaque Psoriasis

Results from a 1-Year, Multicentre, Open-Label, Single-Arm Study in a Clinical Setting
  • Ronald Vender
  • Charles Lynde
  • Vincent Ho
  • Dina Chau
  • Melanie Poulin-Costello
Original Research Article

Abstract

Background: Data investigating the effect of etanercept on work productivity and healthcare resource utilization in Canadian patients in a clinical setting is limited.

Objective: The aim of the study was to describe work productivity and healthcare resource utilization in patients with psoriasis prescribed etanercept.

Methods: A 12-month, phase IV, non-randomized, multicentre, open-label, single-arm prospective trial of patients with moderate-to-severe plaque psoriasis was conducted between March 2006 and July 2009 in 37 community dermatology practice sites across Canada.

A total of 246 patients were enrolled. Major eligibility criteria: ≥18 years of age; diagnosis of moderate-to-severe plaque psoriasis at baseline (Physician Global Assessment [PGA] ≥3, scale 0–5); able to start etanercept therapy as per product monograph.

Patients received etanercept (Enbrel®) 50 mg subcutaneously twice weekly for 3 months, then 50 mg once weekly for 9 months.

Outcomes were measured by average change and average percent change from baseline at months 3, 6, 9 and 12 on the Work Productivity and Activity Im-pairment (WPAI) and Healthcare Resource Utilization (HRU) questionnaires.

Results: The mean degree of impairment while working ± standard deviation (SD) in the total population decreased from 22.7% ±23.2 at baseline to 6.6% ±14 after 3 months of treatment (p < 0.0001). From baseline to 3 months, overall work impairment± SD decreased from 23.7%±23.7 to 8.3%±16.5 (p < 0.0001) and mean activity impairment outside the workplace decreased from 31.4%±26.4 to 12.9%±22.4 (p<0.0001). All these improvements were sustained to month 12.

Other variables that decreased on average from baseline to month 3, sustained to month 12, included physician office visits (2.3/month±3.5 at baseline to 0.6/month± 1.0 at month 3; p<0.0002), hours of assistance required of family and friends to assist with psoriasis (1.1 hours/week ±2.6 at baseline to 0.3 hours/week ± 1.5 at month 3; p = 0.0002) and amount of time spent on activities to manage psoriasis (5.5 hours/week±6.2 at baseline to 1.9 hours/week±3.7 at month 3; p<0.0001). Also, the amount of out-of-pocket expenses to manage psoriasis decreased from $Can94.9/month±331.6 at baseline to $Can35.7±69.1 at month 12 (p = 0.0153).

Conclusions: Use of etanercept in Canadian patients in a clinical practice setting correlated with improvement in work productivity and reduced HRU after 3 months of treatment, and improvement was sustained up to 12 months.

References

  1. 1.
    Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008 May; 58(5): 826–50PubMedCrossRefGoogle Scholar
  2. 2.
    Chan B, Hales B, Shear N, et al. Work-related lost productivity and its economic impact on Canadian patients with moderate to severe psoriasis. J Cutan Med Surg 2009 Jul; 13(4): 192–7PubMedGoogle Scholar
  3. 3.
    Lachaine J, Martel M, Langley R, et al. Health care resource utilization by patients with psoriasis [abstract no. P3303]. J Am Acad Dermatol 2009; 60 (3 Suppl.1): AB162Google Scholar
  4. 4.
    Enbrel® (etanercept): product monograph. Mississauga, ON: Amgen Canada, 2010 Jun 11Google Scholar
  5. 5.
    Leonardi CL, Powers JL, Matheson RT, et al. Etanercept as monotherapy in patients with psoriasis. N Engl J Med 2003 Nov; 349(21): 2014–22PubMedCrossRefGoogle Scholar
  6. 6.
    Papp KA, Tyring S, Lahfa M, et al. A global phase III randomized controlled trial of etanercept in psoriasis: safety, efficacy, and effect of dose reduction. Br J Dermatol 2005 Jun; 152(6): 1304–12PubMedCrossRefGoogle Scholar
  7. 7.
    Moore A, Gordon KB, Kang S, et al. A randomized, open-label trial of continuous versus interrupted etanercept therapy in the treatment of psoriasis. J Am Acad Dermatol 2007 Apr; 56(4): 598–603PubMedCrossRefGoogle Scholar
  8. 8.
    Gelfand JM, Kimball AB, Mostow EN, et al. Patient-reported outcomes and health-care resource utilization in patients with psoriasis treated with etanercept: continuous versus interrupted treatment. Value Health 2008 May; 11(3): 400–7PubMedCrossRefGoogle Scholar
  9. 9.
    Leonardi C, Strober B, Gottlieb AB, et al. Long-term safety and efficacy of etanercept in patients with psoriasis: an open-label study. J Drugs Dermatol 2010 Aug; 9(8): 928–37PubMedGoogle Scholar
  10. 10.
    Papp KA, Poulin Y, Bissonnette R, et al. Assessment of the long-term safety and effectiveness of etanercept for the treatment of psoriasis in an adult population. J Am Acad Dermatol 2012; 66(2): e33–45PubMedCrossRefGoogle Scholar
  11. 11.
    Driessen RJ, Bisschops LA, Adang EM, et al. The economic impact of high-need psoriasis in daily clinical practice before and after the introduction of biologics. Br J Dermatol 2010 Jun; 162(6): 1324–9PubMedCrossRefGoogle Scholar
  12. 12.
    Fonia A, Jackson K, Lereun C, et al. A retrospective cohort study of the impact of biologic therapy initiation on medical resource use and costs in patients with moderate to severe psoriasis. Br J Dermatol 2010 Oct; 163(4): 807–16PubMedCrossRefGoogle Scholar
  13. 13.
    Vender R, Lynde C, Gillbert M, et al. One-year, multicentre, open-label, single-arm study evaluating real-world safety and effectiveness of etanercept for the treatment of moderate-to-severe plaque psoriasis. J Cutan Med Surg. In pressGoogle Scholar
  14. 14.
    Vender R, Lynde C, Gilbert M, et al. Etanercept improves quality-of-life outcomes and treatment satisfaction in patients with moderate-to-severe plaque psoriasis in clinical practice. J Cutan Med Surg. In pressGoogle Scholar
  15. 15.
    Reilly MC, Zbrozek AS, Dukes EM. The validity and re-producibility of a work productivity and activity impairment instrument. Pharmacoeconomics 1993 Nov; 4(5): 353–65PubMedCrossRefGoogle Scholar
  16. 16.
    Reich K, Schenkel B, Zhao N, et al. Ustekinumab decreases work limitations, improves work productivity, and reduces work days missed in patients with moderate-to-severe psoriasis: results from PHOENIX 2. J Dermatolog Treat 2011; 22(6): 337–47PubMedCrossRefGoogle Scholar
  17. 17.
    Tyring S, Gottlieb A, Papp K, et al. Etanercept and clinical outcomes, fatigue, and depression in psoriasis: double-blind placebo-controlled randomised phase III trial. Lancet 2006 Jan; 367(9504): 29–35PubMedCrossRefGoogle Scholar
  18. 18.
    Kimball AB, Yu AP, Signorovitch J, et al. The effects of adalimumab treatment and psoriasis severity on self-reported work productivity and activity impairment for patients with moderate to severe psoriasis. J Am Acad Dermatol 2012; 66(2): e67–76PubMedCrossRefGoogle Scholar
  19. 19.
    Zhang W, Bansback N, Guh D, et al. Short-term influence of adalimumab on work productivity outcomes in patients with rheumatoid arthritis. J Rheumatol 2008 Sep; 35(9): 1729–36PubMedGoogle Scholar
  20. 20.
    Maksymowych WP, Gooch KL, Wong RL, et al. Impact of age, sex, physical function, health-related quality of life, and treatment with adalimumab on work status and work productivity of patients with ankylosing spondylitis. J Rheumatol 2010 Feb; 37(2): 385–92PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2012

Authors and Affiliations

  • Ronald Vender
    • 1
    • 2
  • Charles Lynde
    • 3
    • 4
  • Vincent Ho
    • 5
  • Dina Chau
    • 6
  • Melanie Poulin-Costello
    • 6
  1. 1.Dermatrials ResearchHamiltonCanada
  2. 2.Department of MedicineMcMaster UniversityHamiltonCanada
  3. 3.Lynde Centre for DermatologyMarkhamCanada
  4. 4.Department of MedicineUniversity of TorontoTorontoCanada
  5. 5.Department of Dermatology and Skin Science, The Skin Care CentreUniversity of British ColumbiaVancouverCanada
  6. 6.Amgen Canada Inc.MississaugaCanada

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