Drug Survival of Biological Therapies for Psoriasis Treatment in Germany and Associated Costs: A Retrospective Claims Database Analysis

  • Jörg MahlichEmail author
  • Aranzazu Alba
  • Laila El Hadad
  • Marie-Kristin Leisten
  • Wiebke K. Peitsch
Original Research



Our aim was to study drug survival and associated costs of biologic treatment in a German real-world cohort of biologic-naïve psoriasis patients.


We utilized a German claims database base with 3,682,561 enrolled patients between 2001 and 2015. Kaplan–Meier curves were plotted to show the persistence of different biologics. To determine factors that influence persistence, a Cox regression analysis was performed. In addition, associated costs were calculated 12 months before and after treatment start with biologics.


Among 75,561 patients with a diagnosis of psoriasis, we identified 347 patients who received a biologic; 176 of them were biologic-naïve prior to initiating therapy. Overall, the 1-year persistence rate was 56%. The highest persistence rate was observed for ustekinumab (80%). Younger patients, and those with a high comorbidity index, had a numerically increased risk of treatment discontinuation. However, parameter values were not statistically significant. While the overall costs after treatment start increased due to the acquisition costs of biologics, we found a strong decrease (− 41%) in sick leave after treatment with biologics had been initiated.


Observed drug survival rates in this real-world setting were relatively low. In line with previous studies, ustekinumab had a higher persistence rate than other biologics.




Biologic therapy Costs Claims database Dermatology Drug survival Persistence Psoriasis Real-world data Ustekinumab 




The study was funded by Janssen-Cilag, Neuss, Germany. The sponsor also covered the article processing charges. All authors had full access to all of the data used in this study and take complete responsibility for the accuracy of the data analysis.

Medical Writing and Other Assistance

The manuscript was proof-read by Sabine Reinhold.


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.


Jörg Mahlich is affiliated with Janssen-Cilag, a company that develops and markets drugs for the treatment of psoriasis. Aranzazu Alba received payments from Janssen to perform the statistical analysis. Laila El Hadad received payments from Janssen for data analysis. Marie-Kristin Leisten works for Janssen-Cilag. Wiebke K. Peitsch served as investigator for AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen-Cilag, Merck, Novartis, Pfizer and UCB Pharma; participated in a clinical trial supported by Array Biopharma and MSD; was a member of advisory boards of Eli Lilly, LEO Pharma, MSD, Novartis, Pfizer and UCB Pharma; received speakers’ honoraria from ALK-Abello, AbbVie, Biotest, BMS, Janssen-Cilag, MSD, Novartis, Pfizer, Dr. Pfleger GmbH and Roche; and received support for conferences from AbbVie, Actelion, ALK-Abello, Alma Lasers, Almirall, ARC Lasers, Asclepion, BMS, Celgene, Dermapharm, Dermasence, Galderma, GSK, Janssen-Cilag, L’Oreal, La Roche Posay, LEO Pharma, Medac, MSD, Novartis, Pierre Fabre, P&M Cosmetics, Pfizer, and Roche.

Compliance with Ethics Guidelines

This was a retrospective analysis from health insurance claims data and no institutional review board approval was necessary as this article does not contain any studies with human participants or animals performed by any of the authors.

Data Availability

The datasets generated during and/or analyzed during the current study are not publicly available due to copyright issues but are available from the corresponding author on reasonable request.


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Copyright information

© Springer Healthcare Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Health Economics and Outcomes ResearchNeussGermany
  2. 2.Düsseldorf Institute for Competition Economics (DICE), University of DüsseldorfDüsseldorfGermany
  3. 3.Team GesundheitEssenGermany
  4. 4.Klinik für Dermatologie und Phlebologie, Vivantes Klinikum im FriedrichshainBerlinGermany

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