Work Productivity and Healthcare Resource Utilization Outcomes for Patients on Etanercept for Moderate-to-Severe Plaque Psoriasis
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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.
KeywordsPsoriasis Etanercept Psoriatic Arthritis Work Productivity Plaque Psoriasis
This study was supported in part by Amgen Canada Inc. and Pfizer Canada Inc.
Amgen Canada Inc. oversaw the design, conduct, and collection of data in the study and assisted in the analysis and interpretation of data.
Dr Vender has received honoraria for his roles as investigator, speaker, and for participating in advisory boards from Abbott, Astellas, Pfizer-Amgen, Merck/Schering, Janssen and Ortho Biotech. Dr Lynde has received honoraria and/or grants for his roles as speaker, consultant, and investigator for Abbott, Pfizer-Amgen, Astellas, Galderma, Graceway, Leo Pharma Inc., Merck-Schering, Sanofi Aventis, Schering Plough, Stiefel, Ortho Biotech. Dr Ho has received honoraria and/or grants for his role as investigator and/or speaker for Merck, Abbott, Janessen, Amgen, Novartis and Pfizer; and for participating in advisory boards for Amgen, Astellas, Merck, Novartis, Pfizer, Abbott, Janessen and Basilea. Dr Chau is an employee of Amgen Canada Inc. and has stock options in Amgen Inc. M. Poulin-Costello is an employee of Amgen Canada Inc. and has stock options in Amgen Inc.
We thank Glen Saunders of G. Saunders Enterprises Inc., Drayton Valley, Alberta, for statistical programming support. We thank Jerry Syrotuik, formerly of Amgen Canada Inc., for his contributions to the CAN-EASE study. We also thank Jessica Benzaquen, MSc, and Cheryl D’Abreo, MSc, from The Synapse Group, Burlington, Ontario, who provided medical writing assistance in the form of drafting and revising as per authors’ directions and in accordance with the standards set out by the International Committee of Medical Journal Editors. Medical writing support was funded by Amgen Canada Inc. and Pfizer Canada.
Drs Lynde, Vender, Ho and Chau contributed to the conception and design of the manuscript. Drs Lynde, Vender, Ho and Poulin-Costello contributed to the acquisition of data and critical revision of the manuscript for important intellectual content. All authors contributed to the analysis and interpretation of data and the drafting of the manuscript. Dr Vender acts as guarantor for the content of this manuscript.
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